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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Ambulatory Blood Pressure Phenotypes in Adults Taking Antihypertensive Medication with and without CKD
Stanford E Mwasongwe1, Rikki M Tanner2, Bharat Poudel2
1Jackson Heart Study, Jackson State University, Jackson, Mississippi.
Insights
Ambulatory BP monitoring reveals high rates of uncontrolled blood pressure (BP) phenotypes in Black adults with chronic kidney disease (CKD) on medication. These findings highlight the need for out-of-clinic BP assessments in this population.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Management
Background:
- Recent guidelines advocate for out-of-clinic blood pressure (BP) measurements.
- Chronic kidney disease (CKD) is a significant public health concern, often coexisting with hypertension.
Purpose of the Study:
- To compare the prevalence of BP phenotypes using ambulatory BP monitoring (ABPM) in Black patients with and without CKD.
- To assess the association of CKD and its components (eGFR, albuminuria) with different BP phenotypes.
Main Methods:
- The study analyzed 561 Black participants from the Jackson Heart Study undergoing ABPM.
- CKD was defined by albumin-to-creatinine ratio (ACR) ≥30 mg/g or eGFR <60 ml/min/1.73 m².
- BP phenotypes included sustained controlled/uncontrolled BP, masked uncontrolled hypertension, and white-coat effect.
Main Results:
- CKD was linked to a higher prevalence of uncontrolled clinic BP and sustained uncontrolled BP.
- Reduced eGFR was associated with masked uncontrolled hypertension.
- Albuminuria correlated with uncontrolled clinic BP and sustained uncontrolled BP.
Conclusions:
- The prevalence of various BP phenotypes is substantial among adults with CKD receiving antihypertensive treatment.
- ABPM is crucial for accurately characterizing BP control in CKD patients.
- Findings underscore the importance of comprehensive BP assessment beyond clinic readings for CKD management.
Background And Objectives:
Recent guidelines recommend out-of-clinic BP measurements.
Design, Setting, Participants, & Measurements:
We compared the prevalence of BP phenotypes between 561 black patients, with and without CKD, taking antihypertensive medication who underwent ambulatory BP monitoring at baseline (between 2000 and 2004) in the Jackson Heart Study. CKD was defined as an albumin-to-creatinine ratio ≥30 mg/g or eGFR <60 ml/min per 1.73 m2. Sustained controlled BP was defined by BP at goal both inside and outside of the clinic and sustained uncontrolled BP as BP above goal both inside and outside of the clinic. Masked uncontrolled hypertension was defined by controlled clinic-measured BP with uncontrolled out-of-clinic BP.
Results:
CKD was associated with a higher multivariable-adjusted prevalence ratio for uncontrolled versus controlled clinic BP (prevalence ratio, 1.44; 95% CI, 1.02 to 2.02) and sustained uncontrolled BP versus sustained controlled BP (prevalence ratio, 1.66; 95% CI, 1.16 to 2.36). There were no statistically significant differences in the prevalence of uncontrolled daytime or nighttime BP, nondipping BP, white-coat effect, and masked uncontrolled hypertension between participants with and without CKD after multivariable adjustment. After multivariable adjustment, reduced eGFR was associated with masked uncontrolled hypertension versus sustained controlled BP (prevalence ratio, 1.42; 95% CI, 1.00 to 2.00), whereas albuminuria was associated with uncontrolled clinic BP (prevalence ratio, 1.76; 95% CI, 1.20 to 2.60) and sustained uncontrolled BP versus sustained controlled BP (prevalence ratio, 2.02; 95% CI, 1.36 to 2.99).
Conclusions:
The prevalence of BP phenotypes defined using ambulatory BP monitoring is high among adults with CKD taking antihypertensive medication.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.