Related Experiment Video
Updated: Apr 7, 2026
08:50
5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat
Published on: July 3, 2013
24.5K
Masked Uncontrolled Hypertension in CKD
Rajiv Agarwal1, Maria K Pappas2, Arjun D Sinha2
1Indiana University School of Medicine; Richard L. Roudebush Veterans Affairs Administration Medical Center, Indianapolis, Indiana ragarwal@iu.edu.
Journal of the American Society of Nephrology : JASN
|July 12, 2015
Summary
Masked uncontrolled hypertension (MUCH) is common in CKD patients, often missed in clinic. Ambulatory BP monitoring is reliable for diagnosis, especially when clinic BP is prehypertensive.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Masked uncontrolled hypertension (MUCH) affects treated hypertensive patients who appear normotensive in clinic but are hypertensive outside.
- Chronic kidney disease (CKD) patients are a population where MUCH may be prevalent but underdiagnosed.
Purpose of the Study:
- To evaluate the prevalence and reproducibility of MUCH in veterans with CKD.
- To compare diagnostic accuracy between ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM).
Main Methods:
- Prospective evaluation of 333 veterans with CKD using ABPM and HBPM.
- MUCH was defined using various ABPM (daytime, 24-hour, daytime/nighttime) and HBPM criteria.
- Reproducibility assessed by repeat measurements after 4 weeks.
Main Results:
- MUCH prevalence varied by definition: 26.7% (daytime ABPM) to 56.1% (daytime/nighttime ABPM).
- ABPM showed good reproducibility (κ=0.44-0.51), while HBPM had poor agreement (κ=0.25).
- MUCH prevalence increased with higher clinic systolic BP, with clinic BP predicting MUCH (AUC=0.82).
Conclusions:
- MUCH is common and reproducible in CKD patients.
- Ambulatory BP monitoring is the preferred method for confirming MUCH diagnosis.
- Suspect MUCH when clinic BP is in the prehypertensive range (120-139 mmHg).
Related Concept Videos
01:28Chronic Kidney Disease III: Interprofessional Care
630
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
630
01:25Chronic Kidney Disease I: Introduction
1.2K
Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
1.2K
01:18Chronic Kidney Disease IV: Nursing Management
627
Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of...
627
01:18Hypertension and Regulation of Blood Pressure
4.8K
Hypertension, the most common cardiovascular disease, is diagnosed through repeated measurements of elevated blood pressure. Its risks, including damage to the kidney, heart, and brain, are directly proportional to blood pressure levels. Starting from 115/75 mm Hg, the risk of cardiovascular disease doubles with each increment of 20/10 mm Hg. The diagnosis relies on blood pressure measurements, not on patient symptoms, as hypertension is often asymptomatic until end-organ damage is imminent or...
4.8K
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
729
Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...
729
01:28Antihypertensive Drugs: Potassium-Sparing Diuretics
2.7K
Liddle syndrome is a genetically inherited form of hypertension characterized by the overactivity of epithelial sodium channels in the nephron, the functional unit of the kidney. This heightened activity leads to increased sodium reabsorption and excessive excretion of potassium. To counteract this, potassium-sparing diuretics such as amiloride are used. They function by blocking these sodium channels, thereby reducing the influx of sodium into the epithelial cells and minimizing the loss of...
2.7K