Usefulness of assessing masked and white-coat hypertension by ambulatory blood pressure monitoring for determining prevalent risk of chronic kidney disease: the Ohasama study

Abstract

Masked hypertension (MHT) is considered to be associated with organ damage, whereas the association of white-coat hypertension (WCHT) with organ damage remains controversial. Using home blood pressure measurements, we have previously reported that MHT is associated with a risk of chronic kidney disease (CKD) compared with sustained normal blood pressure (SNBP), although WCHT was not significantly related to CKD in a general Japanese population. The objective of this study was to examine CKD risk associated with WCHT and MHT as determined by ambulatory blood pressure (ABP) monitoring. Among 1023 residents in the general Japanese population of Ohasama, ABP and casual blood pressure (CBP) levels were recorded and blood and urine samples were collected. CKD was defined as a positive proteinuria and/or estimated glomerular filtration rate o60 ml min À1 per 1.73 m 2 . Participants were categorized into four groups using daytime ABP of 140/85 mm Hg and CBP of 140/90 mm Hg as cutoff points: SNBP, 60.0%; WCHT, 15.4%; MHT, 15.0%; and sustained hypertension (SHT), 9.6%. Odds ratios (ORs) for prevalence of CKD were calculated using a multiple logistic regression model. Compared with SNBP, risk of CKD was significantly higher in SHT (OR, 2.81; 95% confidence interval (CI), 1.66-4.75; P¼0.0001), MHT (OR, 2.29; 95% CI, 1.45-3.63; P¼0.0004) and WCHT (OR, 1.67; 95% CI, 1.03-2.71; P¼0.0368). CKD was significantly associated with MHT and WCHT on the basis of ABP monitoring compared with SNBP in the general Japanese population. Keywords: ambulatory blood pressure; chronic kidney disease; masked hypertension; white-coat hypertension INTRODUCTION Ambulatory blood pressure (ABP) has recently been the focus of large amounts of research, and the utility and usefulness of this technique have been recognized and established in the diagnosis and management of hypertension. 1-3 ABP is also considered as a useful tool for detecting overall blood pressure (BP) load, nighttime BP level and circadian and short-term variations in BP. These parameters contribute to the diagnosis and treatment of hypertension. [4][5][6] The measurement of ABP has enabled us to identify a subgroup of individuals with white-coat hypertension (WCHT), showing persistent hypertensive casual BP (CBP) but normal ABP, and a subgroup of individuals with masked hypertension (MHT), showing normal CBP but hypertensive ABP. MHT is reported to be associated strongly with high risk of

Clinical Correlates of Ambulatory BP Monitoring among Patients with CKD

“…Its prevalence has been reported to be 13% (10,28) or 18% (29) among the population in general. Bangash and Agarwal performed a meta-analysis of CKD patients (six trials, reported from 2005 to 2008) and reported that the prevalence was 18.3% (10.5%-31.7%) (30) and 15% among CKD cohort (31). Compared with these previous data, the prevalence of WCHT in this study was very low.…”

Masked hypertension and kidney function decline

“…It has also been associated with increased risk for cardiovascular and cerebrovascular events [12,13]. However, the effect of masked hypertension on the risk for CKD is less clear as prior studies have been cross-sectional or were conducted among people with established CKD [5,14,15]. In addition, there are few data on the association of masked hypertension on kidney outcomes among African-Americans.…”

Masked Hypertension: Does It Lead to CVD or CKD?

“…One study, albeit small, did demonstrate that patients with masked hypertension and CKD did exhibit an increased risk to the development of end-stage renal disease (ESRD) compared to normotensive patients [12]. Much of the available data, however, relate to the prevalence of masked hypertension in a CKD population [13,14].…”