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Relationship between ambulatory BP and clinical outcomes in patients with hypertensive CKD

Francis B Gabbai1, Mahboob Rahman, Bo Hu

  • 1VA San Diego Healthcare System and Department of Medicine, University of California San Diego, CA 92161, USA. fgabbai@ucsd.edu

Clinical Journal of the American Society of Nephrology : CJASN
|September 1, 2012
PubMed

Insights

Ambulatory blood pressure (ABP) monitoring provides crucial prognostic information for kidney disease progression and cardiovascular events in hypertensive chronic kidney disease (CKD) patients. It is particularly valuable for identifying high-risk individuals with seemingly controlled clinic blood pressure.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Management

Background:

  • Abnormal ambulatory blood pressure (ABP) profiles are common in chronic kidney disease (CKD).
  • The prognostic significance of ABP for renal and cardiovascular outcomes in CKD is not fully understood.
  • This study aimed to evaluate the predictive value of baseline ABP profiles for CKD progression and cardiovascular events.

Purpose of the Study:

  • To assess the relationship between baseline ABP profiles and CKD progression.
  • To determine the association of ABP with subsequent cardiovascular outcomes.
  • To ascertain the prognostic value of ABP beyond conventional clinic blood pressure measurements.

Main Methods:

  • A prospective, observational study of 617 African Americans with hypertensive CKD.
  • Participants were treated to a clinic blood pressure goal of <130/80 mmHg.
  • Median follow-up was 5 years, with primary renal and cardiovascular outcomes defined by composite endpoints.

Main Results:

  • Higher 24-hour systolic blood pressure (SBP), daytime, and night-time SBP were associated with increased risk of renal and cardiovascular outcomes.
  • Clinic SBP was also a significant predictor of both renal and cardiovascular outcomes.
  • ABP measures predicted renal outcomes independently of clinic SBP, especially in patients with clinic SBP <130 mmHg.

Conclusions:

  • Ambulatory blood pressure monitoring offers additional prognostic information beyond clinic blood pressure measurements in hypertensive CKD.
  • ABP is particularly useful for identifying high-risk individuals among CKD patients with controlled clinic blood pressure.
  • These findings underscore the importance of ABP monitoring in managing hypertensive CKD.
Abstract

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