Differences between office and 24-hour blood pressure control in hypertensive patients with CKD: A 5,693-patient cross-sectional analysis from Spain.
Title | Differences between office and 24-hour blood pressure control in hypertensive patients with CKD: A 5,693-patient cross-sectional analysis from Spain. |
Publication Type | Journal Article |
Year of Publication | 2013 |
Authors | Gorostidi, M., Sarafidis P. A., de la Sierra A., Segura J., de la Cruz J. J., Banegas J. R., & Ruilope L. M. |
Corporate Authors | Spanish ABPM Registry Investigators |
Journal | Am J Kidney Dis |
Volume | 62 |
Issue | 2 |
Pagination | 285-94 |
Date Published | 2013 Aug |
ISSN | 1523-6838 |
Keywords | Aged, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Cross-Sectional Studies, Female, Humans, Hypertension, Male, Middle Aged, Office Visits, Renal Insufficiency, Chronic, Spain |
Abstract | BACKGROUND: Previous studies have examined control rates of office blood pressure (BP) in chronic kidney disease (CKD). However, recent evidence suggests major discrepancies between office and 24-hour BP values in hypertensive populations. This study examined concordance/discordance between office- and ambulatory-based BP control in a large cohort of patients with CKD.STUDY DESIGN: Cross-sectional.SETTING & PARTICIPANTS: 5,693 hypertensive individuals with CKD stages 1-5 from the Spanish ABPM (ambulatory BP monitoring) Registry.PREDICTORS: Thresholds of 140/90 and 130/80 mm Hg for office BP and 24-hour ambulatory BP, respectively. Age, sex, body mass index, waist circumference, hypertension duration, kidney measures, diabetes, dyslipidemia, target-organ damage, and cardiovascular comorbid conditions.OUTCOMES: Misclassification of BP control as "white-coat" hypertension (office BP ≥140/90 mm Hg, 24-hour BP <130/80 mm Hg) or masked hypertension (office BP <140/90 mm Hg, 24-hour BP ≥130/80 mm Hg).MEASUREMENTS: Standardized office-based BP and 24-hour ABPM.RESULTS: Mean age was 61.0 ± 13.9 (SD) years and 52.6% were men. The proportion with white-coat hypertension was 28.8% (36.8% of patients with office BP ≥140/90 mm Hg) and that of masked hypertension was 7.0% (but 32.1% of patients with office BP <140/90 mm Hg). Female sex, aging, obesity, and target-organ damage were associated with white-coat hypertension; aging and obesity were associated with masked hypertension. Only 21.7% and 8.1% of the CKD population had office BP <140/90 and <130/80 mm Hg, respectively. In contrast, 43.5% of individuals had average 24-hour BP <130/80 mm Hg.LIMITATIONS: Cross-sectional design, longitudinal associations cannot be established.CONCLUSIONS: Misclassification of BP control at the office was observed in 1 of 3 hypertensive patients with CKD. Ambulatory-based control rates were far better than office-based rates. Nevertheless, the burden of uncontrolled ambulatory BP and misclassification of BP control at the office constitutes a call for wider use of ABPM to evaluate the success of hypertension treatment in patients with CKD. |
DOI | 10.1053/j.ajkd.2013.03.025 |
Alternate Journal | Am. J. Kidney Dis. |
PubMed ID | 23689071 |