Discrepancies in Clinic and Ambulatory Blood Pressure in Korean Chronic Kidney Disease Patients

Abstract

Blood pressure (BP) control is considered the most important treatment for preventing chronic kidney disease (CKD) progression and associated cardiovascular complications. However, clinic BP is insufficient to diagnose hypertension (HT) and to monitor overall BP control because it does not correlate well with ambulatory blood pressure monitoring (ABPM). We enrolled 387 hypertensive CKD patients (stages G1–G4, 58.4% male with median age 61 years) from 3 hospitals in Korea. HT of clinic BP and ABPM was classified as ≥ 140/90 and ≥ 130/80 mmHg, respectively. Clinic BP control rate was 60.2%. The median 24-hour systolic blood pressures (SBPs) of CKD G3b and CKD G4 were significantly higher than those of CKD G1–2 and CKD G3a. However, the median 24-hour SBPs were not different between CKD G1–2 and CKD G3a or between CKD G3b and CKD G4. Of all patients, 5.7%, 38.0%. 42.3%, and 14.0% were extreme-dippers, dippers, non-dippers, and reverse-dippers, respectively. Non-/reverse-dippers independently correlated with higher Ca × P product, higher intact parathyroid hormone (iPTH), and lower albumin. Normal BP was 33.3%, and sustained, masked, and white-coat HT were 29.7%, 26.9%, and 10.1%, respectively. White-coat HT independently correlated with age ≥ 61 years and masked HT independently correlated with CKD G3b/G4. In conclusion, ABPM revealed a high prevalence of non-/reverse-dippers and sustained/masked HT in Korean CKD patients. Clinicians should try to obtain a CKD patient's ABPM, especially among those who are older or who have advanced CKD as well as those with abnormal Ca × P product, iPTH, and albumin.

Chronic Kidney Disease affecting the Characteristics of Blood Pressure: An Observational Study

“…In Prakash et al, 15 study mean age was 47.5±14.9 years and study by Singh et al, 16 mean age was 45.22±15.2 years. In our study, the sex ratio was 2.4:1; in study by Iimuro et al 17 (n=682 [63.4%]), Oh et al 18 In our study, 46% had diabetes. In Satoshi Iimuro al 17 381 (35.4%) had diabetes.…”

Association of ambulatory blood pressure monitoring with renal outcome in patients with chronic kidney disease

“…This study was an extension of a 12-month prospective cohort study that enrolled patients with hypertension and CKD stages 1 to 4 from August 2014 to May 2015 from Seoul National University Bundang Hospital, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, and Seoul National University Hospital [12]. The initial inclusion criteria were (1) age 20 to 75 years, (2) BP ≥ 140/90 mmHg, and/or (3) the use of the same BP medication since at least 2 weeks before enrollment.…”

Blood pressure in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…Out-of-office BP measurement is required to diagnose white-coat hypertension (elevated office BP with controlled out-of-office BP) and masked hypertension (controlled office BP with elevated outof-office BP; Figure 1). The prevalence of white-coat hypertension in patients with CKD from several countries ranges from 2% to 41%, 5,[18][19][20][21][22][23][24] and the prevalence of masked hypertension ranges from 6% to 51%. 5,18,19,[21][22][23][24][25] Ambulatory BP provides important information on nocturnal BP.…”

“…The prevalence of white-coat hypertension in patients with CKD from several countries ranges from 2% to 41%, 5,[18][19][20][21][22][23][24] and the prevalence of masked hypertension ranges from 6% to 51%. 5,18,19,[21][22][23][24][25] Ambulatory BP provides important information on nocturnal BP. Patients with CKD are more likely to have an absence or even a reversal of normal nocturnal dipping, with prevalence ranging from 14% to 75%, 18,[20][21][22][26][27][28][29][30][31][32][33][34] which appears to increase with decreasing kidney function.…”

“…5,18,19,[21][22][23][24][25] Ambulatory BP provides important information on nocturnal BP. Patients with CKD are more likely to have an absence or even a reversal of normal nocturnal dipping, with prevalence ranging from 14% to 75%, 18,[20][21][22][26][27][28][29][30][31][32][33][34] which appears to increase with decreasing kidney function. 31 In CKD, out-of-office BP may better predict kidney disease progression and cardiovascular events than office BP.…”