Masked Hypertension and Elevated Nighttime Blood Pressure in CKD
| Autor: | 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, Akinlolu, Ojo |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Ambulatory blood pressure Epidemiology 030232 urology & nephrology Renal function 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Left ventricular hypertrophy Cohort Studies 03 medical and health sciences 0302 clinical medicine Masked Hypertension Internal medicine Prevalence medicine Humans Renal Insufficiency Chronic Pulse wave velocity Aged Transplantation business.industry Original Articles Middle Aged medicine.disease Confidence interval Cross-Sectional Studies Blood pressure Endocrinology Cardiovascular Diseases Nephrology Ambulatory Cardiology Female Kidney Diseases business |
| Zdroj: | Clinical Journal of the American Society of Nephrology. 11:642-652 |
| ISSN: | 1555-9041 |
| DOI: | 10.2215/cjn.08530815 |
| Popis: | Background and objectives Masked hypertension and elevated nighttime BP are associated with increased risk of hypertensive target organ damage and adverse cardiovascular and renal outcomes in patients with normal kidney function. The significance of masked hypertension for these risks in patients with CKD is less well defined. The objective of this study was to evaluate the association between masked hypertension and kidney function and markers of cardiovascular target organ damage, and to determine whether this relationship was consistent among those with and without elevated nighttime BP. Design, setting, participants, & measurements This was a cross-sectional study. We performed 24-hour ambulatory BP in 1492 men and women with CKD enrolled in the Chronic Renal Insufficiency Cohort Study. We categorized participants into controlled BP, white-coat, masked, and sustained hypertension on the basis of clinic and 24-hour ambulatory BP. We obtained echocardiograms and measured pulse wave velocity in 1278 and 1394 participants, respectively. Results The percentages of participants with controlled BP, white-coat, masked, and sustained hypertension were 49.3%, 4.1%, 27.8%, and 18.8%, respectively. Compared with controlled BP, masked hypertension independently associated with low eGFR (−3.2 ml/min per 1.73 m2; 95% confidence interval, −5.5 to −0.9), higher proteinuria (+0.9 unit higher in log2 urine protein; 95% confidence interval, 0.7 to 1.1), and higher left ventricular mass index (+2.52 g/m2.7; 95% confidence interval, 0.9 to 4.1), and pulse wave velocity (+0.92 m/s; 95% confidence interval, 0.5 to 1.3). Participants with masked hypertension had lower eGFR only in the presence of elevated nighttime BP (−3.6 ml/min per 1.73 m2; 95% confidence interval, −6.1 to −1.1; versus −1.4 ml/min per 1.73 m2; 95% confidence interval, −6.9 to 4.0, among those with nighttime BP Conclusions Masked hypertension is common in patients with CKD and associated with lower eGFR, proteinuria, and cardiovascular target organ damage. In patients with CKD, ambulatory BP characterizes the relationship between BP and target organ damage better than BP measured in the clinic alone. |
| Databáze: | OpenAIRE |
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