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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Clinical Utility of 24-h Ambulatory Blood Pressure Monitoring in Hospitalized Patients with Chronic Kidney Disease
Santosh B Salagre1, Nigarbi N A Ansari1, Vandana S Mali1
1Department of Medicine, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India.
Insights
Hypertension significantly impacts chronic kidney disease (CKD) progression. Ambulatory blood pressure monitoring (ABPM) reveals high HTN prevalence in CKD patients and identifies abnormal nighttime BP patterns, crucial for managing kidney disease.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Hypertension is a primary driver of chronic kidney disease (CKD) progression, second only to diabetes.
- Accurate hypertension diagnosis and management are critical for CKD patients.
- Ambulatory blood pressure monitoring (ABPM) offers detailed insights beyond clinic readings.
Purpose of the Study:
- To assess the prevalence of hypertension in CKD patients using ABPM.
- To compare clinic BP measurements with ABPM findings in CKD.
- To investigate nighttime BP patterns and their relation to CKD severity and hypertension types.
Main Methods:
- 192 CKD patients (12-80 years) underwent ABPM using a Meditech ABPM-05 machine.
- Clinic BP measurements were compared with ABPM data.
- Analysis included various BP parameters like HBI, PTE, and dipping status.
Main Results:
- Hypertension prevalence was high (88.02%) in the CKD cohort, with male predominance.
- Clinic BP measurements overestimated BP compared to ABPM, particularly in advanced CKD stages.
- Nighttime BP, HBI, and PTE were elevated in CKD patients, especially those with resistant hypertension. Non-dipping patterns were common.
Conclusions:
- ABPM provides critical data on 24-hour BP control and end-organ damage in CKD patients.
- ABPM is essential for diagnosing various hypertensive patterns like masked and resistant hypertension in CKD.
- Understanding nighttime BP variations via ABPM is key for optimizing CKD management.
Introduction:
Hypertension leads to rapid progression of kidney disease. Hypertension (HTN) is the second most common cause for CKD after diabetes. Ambulatory blood pressure monitoring (ABPM) helps in accurate and early diagnosis of HTN along with measurements of other variables, namely nondippers, reverse dippers, hyperbaric index (HBI), percentage time elevation (PTE), and early morning surge.
Methodology:
After obtaining the institution ethics committee approval total 192 cases, of 12-80 years age group, who were diagnosed with CKD were included in the study. ABPM was done for patients using Meditech ABPM-05 machine.
Results:
Study showed male predominance. Maximum patients were in the age group of 41-60 years. Prevalence of Hypertension in patients with CKD was 88.02%. The systolic BP, diastolic BP, and mean arterial pressure (MAP) were significantly higher by clinic BP measurement than ABPM in all stages of patients with CKD especially in stage IV than stage V CKD. Systolic, diastolic, MAP, HBI and PTE at nighttime were significantly higher than daytime in all patients with CKD, especially in patients with resistant hypertension. Prevalence of whitecoat HTN (4.1%), whitecoat effect (16.1%), resistant hypertension (39.6%), masked HTN (1%), and masked uncontrolled HTN (10.4%) was noted. Systolic and diastolic HBI was lower in patients on hemodialysis as compared to those not on hemodialysis. Non-dippers were more than dippers.
Conclusion:
Apart from mean systolic and diastolic BP, ABPM gives the extent of end-organ damage and insights into the need for control of 24 h BP in patients of CKD.
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