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Relationship between arterial hypertension and renal damage in chronic kidney disease: insights from ABPM

Ernesto Paoletti1, Diego Bellino, Marco Amidone

  • 1Division of Nephrology, Dialysis and Transplantation, Azienda Ospedaliera Universitaria S. Martino, Genova, Italy. ernesto.paoletti@hsanmartino.it

Journal of Nephrology
|December 19, 2006
PubMed

Insights

Proteinuria is the main factor linked to high blood pressure in chronic kidney disease (CKD) patients. Ambulatory blood pressure monitoring (ABPM) effectively identifies hypertension and its relation to kidney damage.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Research

Background:

  • Limited studies have utilized ambulatory blood pressure monitoring (ABPM) in chronic kidney disease (CKD) patients prior to dialysis initiation.
  • Arterial hypertension is a common comorbidity in CKD, significantly impacting patient outcomes.

Purpose of the Study:

  • To investigate the correlates of arterial hypertension in CKD patients using ABPM during their initial nephrology referral.
  • To identify key predictors of elevated blood pressure in non-dialyzed CKD patients.

Main Methods:

  • A cohort of 244 non-diabetic CKD patients underwent 24-hour ABPM.
  • Blood pressure, creatinine clearance (CrCl), hemoglobin (Hgb), serum lipids, intact parathyroid hormone (iPTH), and daily urinary protein (Uprot) and sodium (UNa) excretion were assessed.

Main Results:

  • 81 patients were normotensive, while 164 had some form of hypertension (stable, daytime, or nocturnal).
  • Lower CrCl and higher Uprot were significantly associated with stable and nocturnal hypertension.
  • Urinary protein excretion (Uprot) was the most significant predictor of systolic and pulse pressure in multivariate analysis, particularly for nocturnal hypertension.

Conclusions:

  • Proteinuria is the strongest correlate of arterial hypertension in CKD patients, especially nocturnal hypertension, suggesting vascular damage.
  • ABPM is a reliable tool for assessing the relationship between elevated blood pressure, particularly nocturnal hypertension, and renal damage in pre-dialysis CKD patients.
Abstract

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