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Updated: Jan 23, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Optimal blood pressure target and measurement in patients with chronic kidney disease
Chang Seong Kim1, Hong Sang Choi1, Eun Hui Bae1
1Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Insights
Controlling high blood pressure (hypertension) is challenging in patients with chronic kidney disease (CKD). Accurate blood pressure monitoring, including home or 24-hour ambulatory monitoring, is crucial for effective management.
Area of Science:
- Nephrology
- Cardiology
- Gerontology
Background:
- Hypertension and chronic kidney disease (CKD) prevalence rises with aging populations.
- Hypertension is difficult to manage in CKD patients due to altered diurnal blood pressure (BP) patterns, increased pulse pressure, and BP variability.
- Uncontrolled or nocturnal hypertension in CKD patients elevates risks for cardiovascular disease, CKD progression, and mortality.
Purpose of the Study:
- To highlight the challenges in blood pressure control for patients with chronic kidney disease.
- To emphasize the importance of accurate blood pressure measurement in CKD management.
- To discuss the benefits of out-of-office BP monitoring for assessing diurnal BP variations.
Main Methods:
- Review of current literature on hypertension and CKD.
- Analysis of factors contributing to difficult BP control in CKD.
- Discussion of various BP monitoring techniques, including automated and ambulatory monitoring.
Main Results:
- CKD is associated with abnormal diurnal BP patterns (non-dipping, reverse dipping), nocturnal hypertension, and masked hypertension.
- Intensive systolic BP reduction below 120 mmHg may benefit CKD patients.
- Automated and 24-hour ambulatory BP monitoring offer superior insights compared to in-clinic measurements.
Conclusions:
- Effective BP management in CKD requires understanding and addressing abnormal BP patterns.
- Out-of-office BP monitoring is essential for comprehensive assessment and management of hypertension in CKD.
- Accurate BP measurement strategies are vital for improving outcomes in CKD patients.
Abstract:
The prevalence rates of hypertension and chronic kidney disease (CKD) are increasing with the aging of the population. Hypertension and CKD are closely related, and hypertension with accompanying CKD is difficult to control. This difficulty controlling blood pressure (BP) can be explained by changes in diurnal variation in BP, such as non-dipping and reverse dipping patterns, increased pulse pressure, and BP variability in CKD patients resulting in a high frequency of nocturnal hypertension or masked hypertension. CKD patients with uncontrolled or nocturnal hypertension are at increased risk for cardiovascular disease, progression of CKD, and all-cause death. Recent studies have shown that intensive reduction of systolic BP below 120 mmHg is seems to favor in CKD patients regardless of the presence or absence of diabetes. As BP control is difficult in patients with CKD, appropriate measurement of BP is important. Automated BP monitoring could reduce the so-called "white coat effect" (spike in BP) that may be triggered by measurement in a clinical setting. Moreover, out-of-office BP monitoring at home or ambulatory BP monitoring for 24 hours may provide critical information regarding diurnal BP variability and nocturnal BP in patients with CKD.
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