Ambulatory Blood Pressure in Chronic Kidney Disease: Ready for Prime Time?

Area of Science:

• Nephrology
• Cardiology
• Hypertension Research

Background:

• Hypertension is a primary driver of chronic kidney disease (CKD) progression and cardiovascular complications.
• Accurate blood pressure (BP) measurement is crucial for managing hypertension in CKD patients, where control is often challenging.
• Early antihypertensive treatment is vital to prevent kidney and cardiovascular sequelae in CKD.

Purpose of the Study:

• To review the utility of ambulatory blood pressure monitoring (ABPM) in diagnosing and managing hypertension in CKD.
• To explore the pathophysiology of altered circadian BP rhythms and variability in CKD.
• To examine the role of ABPM-detected BP patterns in CKD outcomes and the potential of antihypertensive chronotherapy.

Main Methods:

• Review of accumulated data and evidence on ABPM in hypertension detection and management.
• Discussion of current understanding of circadian BP rhythm and variability pathophysiology in CKD.
• Examination of emerging antihypertensive chronotherapy strategies based on ABPM findings.

Main Results:

• ABPM demonstrates superior accuracy in hypertension detection compared to office BP measurements.
• ABPM serves as a more effective prognostic marker, identifying high-risk hypertensive CKD patients.
• ABPM reveals associations between circadian BP variation, short-term BP variability, and adverse cardiovascular and renal outcomes in CKD.

Conclusions:

• ABPM is essential for accurate hypertension diagnosis and risk stratification in CKD patients.
• Understanding altered BP patterns via ABPM is key to preventing CKD progression and cardiovascular events.
• Antihypertensive chronotherapy tailored to ABPM data holds promise for optimizing BP management in CKD.