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Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

Masked hypertension and white-coat hypertension in chronic kidney disease: a meta-analysis

Farhan Bangash1, Rajiv Agarwal

  • 1Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Clinical Journal of the American Society of Nephrology : CJASN
|March 6, 2009
PubMed

Insights

Clinic blood pressure (BP) measurements alone misclassify hypertension in many chronic kidney disease (CKD) patients. Out-of-office BP monitoring is crucial for accurate diagnosis and management of hypertension in CKD.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Research

Background:

  • Suboptimal assessment of blood pressure (BP) using clinic measurements alone contributes to poor hypertension control in chronic kidney disease (CKD) patients.
  • White-coat hypertension and masked hypertension are significant concerns in the adult CKD population.

Purpose of the Study:

  • To estimate the prevalence and determinants of white-coat and masked hypertension in adult CKD patients.
  • To highlight the impact of clinic BP measurements on hypertension diagnosis in CKD.

Main Methods:

  • A meta-analysis was performed on data from six studies involving 980 CKD patients.
  • Prevalence and determinants of masked and white-coat hypertension were derived from selected articles.

Main Results:

  • The prevalence of masked hypertension was 8.3% and white-coat hypertension was 18.3% among CKD patients.
  • A significant proportion of CKD patients were misclassified: 40.4% with apparent normotension had home hypertension, and 30.0% with apparent hypertension had home normotension.
  • Classification thresholds for clinic and ambulatory BP influenced the diagnosis of masked versus white-coat hypertension.

Conclusions:

  • Clinic BP measurements alone lead to substantial misclassification, suggesting current estimates of poorly controlled hypertension in CKD may be overestimated.
  • Out-of-office BP monitoring is recommended to improve hypertension management in CKD.
  • Standardized definitions for masked and white-coat hypertension are needed to advance research.
Abstract

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