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Prognostic Significance of Ambulatory BP Monitoring in CKD: A Report from the Chronic Renal Insufficiency Cohort

Mahboob Rahman1, Xue Wang2, Joshua D Bundy3

  • 1Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio Mahboob.Rahman@uhhospitals.org.

Journal of the American Society of Nephrology : JASN
|September 25, 2020
PubMed

Insights

Ambulatory BP monitoring provides valuable risk assessment for patients with chronic kidney disease (CKD). Key findings show masked uncontrolled hypertension and elevated 24-hour systolic BP increase cardiovascular and kidney disease risks.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Management

Background:

  • The clinical utility of ambulatory BP monitoring (ABPM) in predicting outcomes for patients with chronic kidney disease (CKD) remains uncertain.
  • CKD patients face elevated risks for cardiovascular events and kidney disease progression.

Purpose of the Study:

  • To investigate the association between ABPM-derived BP metrics and major adverse outcomes in a cohort of patients with CKD.
  • To determine if ABPM offers prognostic value beyond traditional clinic BP measurements.

Main Methods:

  • A prospective cohort study of 1502 participants from the Chronic Renal Insufficiency Cohort (CRIC) Study.
  • Evaluation of ABPM profiles (masked uncontrolled hypertension, white-coat effect, sustained hypertension, controlled BP), mean BP, and diurnal BP variation (dipper, nondipper, reverse-dipper).
  • Outcomes included composite cardiovascular disease, kidney disease (ESKD or eGFR halving), and mortality over a mean follow-up of 6.72 years.

Main Results:

  • Masked uncontrolled hypertension was independently linked to increased cardiovascular and kidney outcomes compared to controlled BP.
  • Higher mean 24-hour systolic BP was associated with greater risk of cardiovascular outcomes, kidney outcomes, and mortality, irrespective of clinic BP.
  • The reverse-dipper BP profile (higher nighttime BP) correlated with an elevated risk of kidney disease progression.

Conclusions:

  • ABPM-derived BP metrics are significant independent predictors of cardiovascular events, kidney disease progression, and mortality in patients with CKD.
  • Masked uncontrolled hypertension and elevated mean 24-hour BP identify high-risk individuals for cardiovascular disease and CKD progression.
  • Abnormal diurnal BP variation patterns are associated with adverse renal and cardiovascular outcomes, supporting wider ABPM adoption in CKD hypertension management.
Abstract

Keywords:
ambulatory BP monitoringchronic kidney diseasehypertension

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