Hypertension diagnosis and prognosis in chronic kidney disease with out-of-office blood pressure monitoring.

PURPOSE OF REVIEW: Hypertension is an important risk factor for adverse cardiovascular and renal outcomes particularly in patients with chronic kidney disease. This review compares blood pressure measurements obtained in the clinic with those obtained outside the clinic to predict cardiovascular and renal injury and outcomes. RECENT
FINDINGS: When home blood pressure monitoring (self-measured blood pressure) is performed, hypertension is less frequently misclassified and better correlation is achieved with putative markers of kidney disease progression. Masked hypertension - normotension in the clinic, hypertension at home - is associated with higher risk of end-stage renal disease in patients with chronic kidney disease. Conversely, 'white coat' hypertension - hypertension in the clinic and normotension at home - is associated with better renal outcomes. Ambulatory blood pressure monitoring is also prognostically superior to clinic blood pressure but does not further refine the prognosis made by home blood pressure monitoring. In patients on hemodialysis, home blood pressure, not predialysis and postdialysis blood pressure, shares the combination of high sensitivity and high specificity of greater than 80% to make a diagnosis of hypertension with the reference standard of ambulatory blood pressure monitoring. In addition, home blood pressure is a better correlate of left ventricular hypertrophy in patients on hemodialysis compared with peridialysis blood pressure.
SUMMARY: Home blood pressure monitoring should be an essential part of management of hypertension in patients with all stages of chronic kidney disease.