Related Experiment Video
Updated: Jun 28, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Prevalence and factors associated with masked hypertension in chronic kidney disease
Frédéric Legrand1, Justina Motiejunaite2,3,4, Florence Arnoult2
1Faculté de médecine, Sorbonne Université.
Insights
Masked hypertension, where blood pressure is normal in the clinic but high at home, affects over half of chronic kidney disease patients with controlled office blood pressure. Routine ambulatory blood pressure monitoring (ABPM) is recommended for better cardiovascular risk management in CKD.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Optimal blood pressure (BP) control is crucial for preventing cardiovascular complications in patients with chronic kidney disease (CKD).
- Masked hypertension, characterized by normal office BP but elevated out-of-office BP, is a significant concern in CKD management.
- Understanding the prevalence and contributing factors of masked hypertension is essential for improving patient outcomes.
Purpose of the Study:
- To determine the prevalence of masked hypertension in patients with chronic kidney disease.
- To identify clinical and demographic factors associated with masked hypertension in this population.
Main Methods:
- Analysis of 1113 ambulatory 24-hour BP monitoring (ABPM) records from 632 patients undergoing kidney function evaluation.
- Definition of masked hypertension: office BP <140/90 mmHg and daytime BP ≥135/85 mmHg or nighttime BP ≥120/70 mmHg.
- Mixed logistic regression models were used to assess factors associated with masked hypertension.
Main Results:
- Among patients with controlled office BP (67% of the cohort), 56% exhibited masked hypertension.
- Factors associated with masked hypertension included male sex, Sub-Saharan African origin, higher BMI, and albuminuria.
- Negative associations were observed with plasma potassium, 24-hour urinary potassium excretion, and the use of RAAS blockers and diuretics.
Conclusions:
- Routine ABPM is supported in CKD patients, as masked hypertension is highly prevalent even with controlled office BP.
- Strategies such as weight management, potassium monitoring and supplementation (cautiously), and increased use of RAAS blockers and diuretics may improve out-of-office BP control.
- These findings highlight the importance of comprehensive BP monitoring beyond in-office measurements for effective CKD management.
Objectives:
Optimal blood pressure (BP) control is key to prevent cardiovascular complications in patients with chronic kidney disease (CKD). We described the prevalence and factors associated with masked hypertension in CKD.
Methods:
We analyzed 1113 ambulatory 24-h BP monitoring (ABPM) records of 632 patients referred for kidney function evaluation. Masked hypertension was defined as office BP less than 140/90 mmHg but daytime BP at least 135/85 mmHg or nighttime BP at least 120/70 mmHg. Factors associated with masked hypertension were assessed with mixed logistic regression models.
Results:
At inclusion, 424 patients (67%) had controlled office BP, of whom 56% had masked hypertension. In multivariable analysis conducted in all visits with controlled office BP ( n = 782), masked hypertension was positively associated with male sex [adjusted OR (95% confidence interval) 1.91 (1.16-3.27)], sub-Saharan African origin [2.51 (1.32-4.63)], BMI [1.11 (1.01-1.17) per 1 kg/m 2 ], and albuminuria [1.29 [1.12 - 1.47] per 1 log unit), and was negatively associated with plasma potassium (0.42 [0.29 - 0.71] per 1 mmol/L) and 24-h urinary potassium excretion (0.91 [0.82 - 0.99] per 10 mmol/24 h) as well as the use of renin-angiotensin-aldosterone (RAAS) blockers (0.56 [0.31 - 0.97]) and diuretics (0.41 [0.27 - 0.72]).
Conclusion:
Our findings support the routine use of ABPM in CKD, as more than half of the patients with controlled office BP had masked hypertension. Weight control, higher potassium intake (with caution in advanced CKD), correction of hypokalemia, and larger use of diuretics and RAAS blockers could be potential levers for better out-of-office BP control.
Related Concept Videos
01:18Hypertension and Regulation of Blood Pressure
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:28Factors affecting Blood pressure
Physiological Factors:
01:28Antihypertensive Drugs: Potassium-Sparing Diuretics
01:25Antihypertensive Drugs: Direct Renin Inhibitors
01:30Alterations in Blood Pressure
Hypertension (High blood pressure)
Hypertension occurs when blood pressure readings consistently exceed the normal range. It is diagnosed when systolic blood pressure (the top number, indicating pressure while the heart...