BACKGROUND: Previous studies have examined control rates of office blood pressure (BP) in chronic kidney disease (CKD). However, recent evidence suggests major discrepancies between office and 24-hour BP values in hypertensive populations. This study examined concordance/discordance between office- and ambulatory-based BP control in a large cohort of patients with CKD. STUDY DESIGN: Cross-sectional. SETTING & PARTICIPANTS: 5,693 hypertensive individuals with CKD stages 1-5 from the Spanish ABPM (ambulatory BP monitoring) Registry. PREDICTORS: Thresholds of 140/90 and 130/80 mm Hg for office BP and 24-hour ambulatory BP, respectively. Age, sex, body mass index, waist circumference, hypertension duration, kidney measures, diabetes, dyslipidemia, target-organ damage, and cardiovascular comorbid conditions. OUTCOMES: Misclassification of BP control as "white-coat" hypertension (office BP ≥140/90 mm Hg, 24-hour BP <130/80 mm Hg) or masked hypertension (office BP <140/90 mm Hg, 24-hour BP ≥130/80 mm Hg). MEASUREMENTS: Standardized office-based BP and 24-hour ABPM. RESULTS: Mean age was 61.0 ± 13.9 (SD) years and 52.6% were men. The proportion with white-coat hypertension was 28.8% (36.8% of patients with office BP ≥140/90 mm Hg) and that of masked hypertension was 7.0% (but 32.1% of patients with office BP <140/90 mm Hg). Female sex, aging, obesity, and target-organ damage were associated with white-coat hypertension; aging and obesity were associated with masked hypertension. Only 21.7% and 8.1% of the CKD population had office BP <140/90 and <130/80 mm Hg, respectively. In contrast, 43.5% of individuals had average 24-hour BP <130/80 mm Hg. LIMITATIONS: Cross-sectional design, longitudinal associations cannot be established. CONCLUSIONS: Misclassification of BP control at the office was observed in 1 of 3 hypertensive patients with CKD. Ambulatory-based control rates were far better than office-based rates. Nevertheless, the burden of uncontrolled ambulatory BP and misclassification of BP control at the office constitutes a call for wider use of ABPM to evaluate the success of hypertension treatment in patients with CKD.
BACKGROUND: Previous studies have examined control rates of office blood pressure (BP) in chronic kidney disease (CKD). However, recent evidence suggests major discrepancies between office and 24-hour BP values in hypertensive populations. This study examined concordance/discordance between office- and ambulatory-based BP control in a large cohort of patients with CKD. STUDY DESIGN: Cross-sectional. SETTING & PARTICIPANTS: 5,693 hypertensive individuals with CKD stages 1-5 from the Spanish ABPM (ambulatory BP monitoring) Registry. PREDICTORS: Thresholds of 140/90 and 130/80 mm Hg for office BP and 24-hour ambulatory BP, respectively. Age, sex, body mass index, waist circumference, hypertension duration, kidney measures, diabetes, dyslipidemia, target-organ damage, and cardiovascular comorbid conditions. OUTCOMES: Misclassification of BP control as "white-coat" hypertension (office BP ≥140/90 mm Hg, 24-hour BP <130/80 mm Hg) or masked hypertension (office BP <140/90 mm Hg, 24-hour BP ≥130/80 mm Hg). MEASUREMENTS: Standardized office-based BP and 24-hour ABPM. RESULTS: Mean age was 61.0 ± 13.9 (SD) years and 52.6% were men. The proportion with white-coat hypertension was 28.8% (36.8% of patients with office BP ≥140/90 mm Hg) and that of masked hypertension was 7.0% (but 32.1% of patients with office BP <140/90 mm Hg). Female sex, aging, obesity, and target-organ damage were associated with white-coat hypertension; aging and obesity were associated with masked hypertension. Only 21.7% and 8.1% of the CKD population had office BP <140/90 and <130/80 mm Hg, respectively. In contrast, 43.5% of individuals had average 24-hour BP <130/80 mm Hg. LIMITATIONS: Cross-sectional design, longitudinal associations cannot be established. CONCLUSIONS: Misclassification of BP control at the office was observed in 1 of 3 hypertensivepatients with CKD. Ambulatory-based control rates were far better than office-based rates. Nevertheless, the burden of uncontrolled ambulatory BP and misclassification of BP control at the office constitutes a call for wider use of ABPM to evaluate the success of hypertension treatment in patients with CKD.
Authors: Paul E Drawz; Arnold B Alper; Amanda H Anderson; Carolyn S Brecklin; Jeanne Charleston; Jing Chen; Rajat Deo; Michael J Fischer; Jiang He; Chi-Yuan Hsu; Yonghong Huan; Martin G Keane; John W Kusek; Gail K Makos; Edgar R Miller; Elsayed Z Soliman; Susan P Steigerwalt; Jonathan J Taliercio; Raymond R Townsend; Matthew R Weir; Jackson T Wright; Dawei Xie; Mahboob Rahman Journal: Clin J Am Soc Nephrol Date: 2016-02-18 Impact factor: 8.237
Authors: Paul E Drawz; Roland Brown; Luca De Nicola; Naohiko Fujii; Francis B Gabbai; Jennifer Gassman; Jiang He; Satoshi Iimuro; James Lash; Roberto Minutolo; Robert A Phillips; Kyle Rudser; Luis Ruilope; Susan Steigerwalt; Raymond R Townsend; Dawei Xie; Mahboob Rahman Journal: Clin J Am Soc Nephrol Date: 2018-07-05 Impact factor: 8.237
Authors: Samantha G Bromfield; John N Booth; Matthew S Loop; Joseph E Schwartz; Samantha R Seals; Stephen J Thomas; Yuan-I Min; Gbenga Ogedegbe; Daichi Shimbo; Paul Muntner Journal: Blood Press Monit Date: 2018-04 Impact factor: 1.444