J Korean Med Sci.  2017 May;32(5):772-781. 10.3346/jkms.2017.32.5.772.

Discrepancies in Clinic and Ambulatory Blood Pressure in Korean Chronic Kidney Disease Patients

• Oh YK
• Chin HJ
• Ahn SY
• An JN
• Lee JP
• Lim CS
• Oh KH

• KMID: 2375077
• DOI: http://doi.org/10.3346/jkms.2017.32.5.772

Abstract

Blood pressure (BP) control is considered the most important treatment for preventing chronic kidney disease (CKD) progression and associated cardiovascular complications. However, clinic BP is insufficient to diagnose hypertension (HT) and to monitor overall BP control because it does not correlate well with ambulatory blood pressure monitoring (ABPM). We enrolled 387 hypertensive CKD patients (stages G1-G4, 58.4% male with median age 61 years) from 3 hospitals in Korea. HT of clinic BP and ABPM was classified as ≥ 140/90 and ≥ 130/80 mmHg, respectively. Clinic BP control rate was 60.2%. The median 24-hour systolic blood pressures (SBPs) of CKD G3b and CKD G4 were significantly higher than those of CKD G1-2 and CKD G3a. However, the median 24-hour SBPs were not different between CKD G1-2 and CKD G3a or between CKD G3b and CKD G4. Of all patients, 5.7%, 38.0%. 42.3%, and 14.0% were extreme-dippers, dippers, non-dippers, and reverse-dippers, respectively. Non-/reverse-dippers independently correlated with higher Ca × P product, higher intact parathyroid hormone (iPTH), and lower albumin. Normal BP was 33.3%, and sustained, masked, and white-coat HT were 29.7%, 26.9%, and 10.1%, respectively. White-coat HT independently correlated with age ≥ 61 years and masked HT independently correlated with CKD G3b/G4. In conclusion, ABPM revealed a high prevalence of non-/reverse-dippers and sustained/masked HT in Korean CKD patients. Clinicians should try to obtain a CKD patient's ABPM, especially among those who are older or who have advanced CKD as well as those with abnormal Ca × P product, iPTH, and albumin.

Keyword

Ambulatory Blood Pressure Monitoring; Blood Pressure; Chronic Kidney Disease; Hypertension; Masked Hypertension; White-Coat Hypertension

MeSH Terms

Blood Pressure Monitoring, Ambulatory
Blood Pressure*
Humans
Hypertension
Korea
Male
Masked Hypertension
Masks
Parathyroid Hormone
Prevalence
Renal Insufficiency, Chronic*
Parathyroid Hormone

Figure

• 

  Fig. 1 Diagram of patients enrollment. A total of 433 CKD patients agreed to undergo ABPM, and 46 patients were excluded from the analysis.CKD = chronic kidney disease, ABPM = ambulatory blood pressure monitoring.

• 

  Fig. 2 Clinic BP values and ABPM SBPs values according to CKD stages.(A) Clinic SBP. (B) Clinic DBP. (C) 24-hour SBP. (D) Daytime SBP. (E) Nighttime SBP.BP = blood pressure, ABPM = ambulatory blood pressure monitoring, CKD = chronic kidney disease, DBP = diastolic blood pressure, SBP = systolic blood pressure.

• 

  Fig. 3 Correlation of Ca × P and iPTH with nighttime/daytime SBP ratio. (A) Ca × P product. (B) iPTH.Ca = calcium, P = phosphorus, iPTH = intact parathyroid hormone, SBP = systolic blood pressure.

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