Disparate Estimates of Hypertension Control From Ambulatory and Clinic Blood Pressure Measurements in Hypertensive Kidney Disease

Division of Nephrology, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY 10037, USA.
Hypertension (Impact Factor: 6.48). 01/2009; 53(1):20-7. DOI: 10.1161/HYPERTENSIONAHA.108.115154
Source: PubMed


Ambulatory blood pressure (ABP) monitoring provides unique information about day-night patterns of blood pressure (BP). The objectives of this article were to describe ABP patterns in African Americans with hypertensive kidney disease, to examine the joint distribution of clinic BP and ABP, and to determine associations of hypertensive target organ damage with clinic BP and ABP. This study is a cross-sectional analysis of baseline data from the African American Study of Kidney Disease Cohort Study. Masked hypertension was defined by elevated daytime (>or= 135/85 mm Hg) or elevated nighttime (>or= 120/70 mm Hg) ABP in those with controlled clinic BP (<140/90 mm Hg); nondipping was defined by a <or= 10% decrease in mean nighttime systolic BP; reverse dipping was defined by a higher nighttime than daytime systolic BP. Of the 617 participants (mean age: 60.2 years; 62% male; mean estimated glomerular filtration rate: 43.8 mL/min per 1.73 m(2)) with both clinic BP and ABP, 498 participants (80%) had a nondipping or reverse dipping profile. Of the 377 participants with controlled clinic BP (61%), 70% had masked hypertension. Compared with those with controlled clinic BP or white-coat hypertension, target organ damage (proteinuria and left ventricular hypertrophy) was more common in those with elevated nighttime BP, masked hypertension, or sustained hypertension. In conclusion, clinic BP provides an incomplete and potentially misleading assessment of the severity of hypertension in African Americans with hypertensive kidney disease, in large part because of increased nighttime BP. Whether lowering nighttime BP improves clinical outcomes is unknown but should be tested given the substantial burden of BP-related morbidity in this population.

Download full-text


Available from: Mohammed Sika, Oct 06, 2015
21 Reads
  • Source
    • "This is comparable with ambulatory BP reduction of 10/4 mm Hg as reported in our previous publication [2]. While ambulatory BP is considered to be more strongly related to cardiovascular and renal risk than clinic BP [15,16], reporting both measurements allows for greater comparability with studies using either of these measurements alone. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Dietary sodium restriction is a key management strategy in chronic kidney disease (CKD). Recent evidence has demonstrated short-term reduction in blood pressure (BP) and proteinuria with sodium restriction, however the effect on other cardiovascular-related risk factors requires investigation in CKD. The LowSALT CKD study involved 20 hypertensive Stage III-IV CKD patients counselled by a dietitian to consume a low-sodium diet (<100 mmol/day). The study was a randomised crossover trial comparing 2 weeks of high-sodium (additional 120 mmol sodium tablets) and low-sodium intake (placebo). Measurements were taken after each crossover arm including BP (peripheral and central), adipokines (inflammation markers and adiponectin), volume markers (extracellular-to-intracellular [E/I] fluid ratio; N-terminal pro-brain natriuretic peptide [NT-proBNP]), kidney function (estimated Glomerular Filtration Rate [eGFR]) and proteinuria (urine protein-creatinine ratio [PCR] and albumin-creatinine ratio [ACR]). Outcomes were compared using paired t-test for each cross-over arm. BP-lowering benefits of a low-sodium intake (peripheral BP (mean +/- SD) 148/82 +/- 21/12 mmHg) from high-sodium (159/87 +/- 15/10 mmHg) intake were reflected in central BP and a reduction in eGFR, PCR, ACR, NTproBNP and E/I ratio. There was no change in inflammatory markers, total or high molecular weight adiponectin. Short-term benefits of sodium restriction on BP were reflected in significant change in kidney function and fluid volume parameters. Larger, long-term adequately powered trials in CKD are necessary to confirm these results.Trial registration: Universal Trial Number U1111-1125-2149 registered on 13/10/2011; Australian New Zealand Clinical Trials Registry Number ACTRN12611001097932 registered on 21/10/2011.
    BMC Nephrology 04/2014; 15(1):57. DOI:10.1186/1471-2369-15-57 · 1.69 Impact Factor
  • Source
    • "The regression slope of DBP on SBP was computed to obtain the AASI (1-slope). The diagnosis of hypertension was based on accepted criteria for ABPM [15]: ambulatory blood pressure was considered to be “normal” if the mean awake BP was <135/85 mmHg for SBP/DBP or if the mean bedtime BP was <120/70 mmHg. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The ambulatory arterial stiffness index (AASI) can be used to predict cardiovascular morbidity and mortality in hypertensive patients. However, data on AASI in Chinese patients with chronic kidney disease (CKD) is not available. This cross-sectional study enrolled 583 CKD patients. Univariate and multivariate analyses were used to evaluate the relationship between AASI and renal function and parameters of cardiovascular injury. Patients with a higher AASI had a higher systolic blood pressure, a lower estimated glomerular filtration rate (eGFR), a higher serum cystatin C, a higher left ventricular mass index (LVMI) and carotid intima-media thickness (cIMT). Univariate analyses showed that AASI was positively correlated with serum cystatin C (r=0.296, P < 0.001), serum creatinine (r=0.182, P < 0.001), and LVMI (r = 0.205, P < 0.001) and negatively correlated with the eGFR (r = --0.200, P < 0.001). Multivariate analyses revealed that serum cystatin C, eGFR, serum creatinine and LVMI were independently correlated with AASI. These data suggest that AASI was closely correlated with renal function and parameters of cardiovascular injury in Chinese CKD patients. Good quality, long-term, large longitudinal trials to validate the role of AASI in clinical practice for Chinese CKD patients.
    BMC Nephrology 11/2013; 14(1):257. DOI:10.1186/1471-2369-14-257 · 1.69 Impact Factor
  • Source
    • "A number of primary care studies have investigated the difference between routine office BP measurements and average BpTRU readings. Three studies restricted their subjects to patients with an existing diagnosis of hypertension [29,33,34]; one study included both hypertensive and normotensive patients [39]. Beckett & Godwin showed that average BpTRU readings were significantly lower than the average of the routine office BP measurements taken at the last three clinic visits [29]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Accurate blood pressure monitoring is critical for the management of chronic kidney disease, but changes in management in secondary care clinics may be based on a single blood pressure reading, with a subsequent lack of accuracy. The aim of this study was to evaluate a fully automated sphygmomanometer for optimising the accuracy of blood pressure measurements in the setting of secondary care renal clinics. Patients had routine blood pressure measurements with a calibrated DINAMAP PRO400 monitor in a clinical assessment room. Patients then underwent repeat assessment with a DINAMAP PRO400 monitor and BpTRU device and subsequent 24 hour ambulatory blood pressure monitoring (ABPM). The BpTRU systolic (+/- SD) reading (117.3 +/- 14.1 mmHg) was significantly lower than the routine clinic mean systolic blood pressure (143.8 +/- 15.5 mmHg; P < 0.001) and the repeat blood pressure taken with a DINAMAP PRO400 monitor in a quiet room (129.9 +/- 19.9 mmHg; P < 0.001). The routine clinic mean diastolic (82.4 +/- 11.2 mmHg) was significantly higher than the BpTRU reading (78.4 +/- 10.0 mmHg; P < 0.001). Clinic BpTRU measurements were not significantly different to the daytime mean or overall mean of 24 hour ABPM. In patients with CKD, routine clinic blood pressure measurements were significantly higher than measurements using a BpTRU machine in a quiet room, but there was no significant difference in this setting between BpTRU readings and 24 hour ABPM. Adjusting clinic protocols to utilise the most accurate blood pressure technique available is a simple manoeuvre that could deliver major improvements in clinical practice.
    BMC Nephrology 10/2013; 14(1):218. DOI:10.1186/1471-2369-14-218 · 1.69 Impact Factor
Show more