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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Home blood pressure monitoring in CKD
Martin J Andersen1, Wassim Khawandi, Rajiv Agarwal
1Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN 46202, USA.
Insights
Home blood pressure (HBP) monitoring is superior to clinic blood pressure (CBP) readings for accurately diagnosing hypertension in chronic kidney disease (CKD) patients. HBP reduces misclassification from white-coat effect and masked hypertension, improving cardiorenal disease management.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Management
Background:
- Blood pressure control is crucial for managing cardiorenal disease progression.
- The diagnostic accuracy of clinic blood pressure (CBP) and home blood pressure (HBP) for hypertension in chronic kidney disease (CKD) is not well-established.
Purpose of the Study:
- To compare the performance of CBP and HBP in diagnosing hypertension and assessing BP control in CKD patients.
- To evaluate the impact of white-coat effect and masked hypertension on hypertension diagnosis using different BP measurement methods.
Main Methods:
- 232 CKD patients underwent 24-hour ambulatory BP monitoring (ABPM).
- Clinic BP (CBP) and home BP (HBP) were recorded concurrently for 1 week.
- Hypertension was defined by average awake 24-hour ABPM (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg).
Main Results:
- Average ABPM was 135.2/75.6 mm Hg; 65% of patients had hypertension.
- White-coat effect prevalence was 28-30% with CBP and 24% with HBP.
- CBP masked hypertension in 26-29% of cases, while HBP masked it in only 13%.
Conclusions:
- Home blood pressure (HBP) monitoring is more effective than clinic blood pressure (CBP) in reducing hypertension misclassification in CKD patients.
- HBP minimizes errors from white-coat effect and masked hypertension.
- An average HBP of ~140/80 mm Hg correlates best with ABPM-defined hypertension in CKD.
Background:
Blood pressure (BP) control is the mainstay of stalling the progression of cardiorenal disease, yet the performance characteristics of BPs obtained in the clinic (CBPs) by routine or standardized methods or at home (HBP) in diagnosing hypertension or assessing its control are unknown.
Methods:
Two hundred thirty-two patients (20% black; 4% women; mean age, 67 years; 35% with diabetes) with chronic kidney disease (CKD) underwent a single 24-hour ambulatory BP (ABP) monitoring (ABPM) and concomitant recording of CBP and HBP for 1 week. Hypertension is defined as systolic BP of 130 mm Hg or greater or diastolic BP of 80 mm Hg or greater on average awake 24-hour ABPM.
Results:
Average ABP was 135.2 +/- 15.9/75.6 +/- 11.0 mm Hg. Thirty-five percent of patients had isolated systolic hypertension; 3%, isolated diastolic hypertension; 27%, combined systolic and diastolic hypertension; and 35%, normotension or well-controlled BP. The prevalence of "white-coat effect" was estimated as 28% to 30% by means of CBPs and 24% by means of HBPs. Well-controlled BP in the clinic, but poorly controlled BP by means of ABPM, masked hypertension, was seen in 26% to 29% by means of CBPs, but only 13% with HBP monitoring.
Conclusion:
In patients with CKD, HBP is superior in reducing the misclassification of hypertension caused by the white-coat effect and masked hypertension commonly seen with CBPs. An average HBP of approximately 140/80 mm Hg appears to be the best correlate of hypertension defined by means of ABPM.
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Preparation: