Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Prevalence and Association with Target Organ Damage

Chronic Renal Insufficiency Cohort Study Investigators

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND OBJECTIVES: Masked hypertension and elevated nighttime BP are associated with increased risk of hypertensive target organ damage and adverse cardiovascular and renal outcomes in patients with normal kidney function. The significance of masked hypertension for these risks in patients with CKD is less well defined. The objective of this study was to evaluate the association between masked hypertension and kidney function and markers of cardiovascular target organ damage, and to determine whether this relationship was consistent among those with and without elevated nighttime BP.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a cross-sectional study. We performed 24-hour ambulatory BP in 1492 men and women with CKD enrolled in the Chronic Renal Insufficiency Cohort Study. We categorized participants into controlled BP, white-coat, masked, and sustained hypertension on the basis of clinic and 24-hour ambulatory BP. We obtained echocardiograms and measured pulse wave velocity in 1278 and 1394 participants, respectively.

RESULTS: The percentages of participants with controlled BP, white-coat, masked, and sustained hypertension were 49.3%, 4.1%, 27.8%, and 18.8%, respectively. Compared with controlled BP, masked hypertension independently associated with low eGFR (-3.2 ml/min per 1.73 m(2); 95% confidence interval, -5.5 to -0.9), higher proteinuria (+0.9 unit higher in log2 urine protein; 95% confidence interval, 0.7 to 1.1), and higher left ventricular mass index (+2.52 g/m(2.7); 95% confidence interval, 0.9 to 4.1), and pulse wave velocity (+0.92 m/s; 95% confidence interval, 0.5 to 1.3). Participants with masked hypertension had lower eGFR only in the presence of elevated nighttime BP (-3.6 ml/min per 1.73 m(2); 95% confidence interval, -6.1 to -1.1; versus -1.4 ml/min per 1.73 m(2); 95% confidence interval, -6.9 to 4.0, among those with nighttime BP <120/70 mmHg; P value for interaction with nighttime systolic BP 0.002).

CONCLUSIONS: Masked hypertension is common in patients with CKD and associated with lower eGFR, proteinuria, and cardiovascular target organ damage. In patients with CKD, ambulatory BP characterizes the relationship between BP and target organ damage better than BP measured in the clinic alone.

Original languageEnglish (US)
Pages (from-to)642-652
Number of pages11
JournalClinical journal of the American Society of Nephrology : CJASN
Volume11
Issue number4
DOIs
StatePublished - Apr 7 2016

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Masked Hypertension
Blood Pressure
Confidence Intervals
Pulse Wave Analysis
Kidney
Proteinuria
Chronic Renal Insufficiency
Cohort Studies
Cross-Sectional Studies
Urine

Keywords

  • ambulatory blood pressure monitoring
  • blood pressure
  • cardiovascular disease
  • chronic kidney disease
  • humans
  • hypertension
  • left ventricular hypertrophy
  • masked hypertension
  • nighttime
  • pulse wave analysis

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD : Prevalence and Association with Target Organ Damage. / Chronic Renal Insufficiency Cohort Study Investigators.

In: Clinical journal of the American Society of Nephrology : CJASN, Vol. 11, No. 4, 07.04.2016, p. 642-652.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND AND OBJECTIVES: Masked hypertension and elevated nighttime BP are associated with increased risk of hypertensive target organ damage and adverse cardiovascular and renal outcomes in patients with normal kidney function. The significance of masked hypertension for these risks in patients with CKD is less well defined. The objective of this study was to evaluate the association between masked hypertension and kidney function and markers of cardiovascular target organ damage, and to determine whether this relationship was consistent among those with and without elevated nighttime BP.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a cross-sectional study. We performed 24-hour ambulatory BP in 1492 men and women with CKD enrolled in the Chronic Renal Insufficiency Cohort Study. We categorized participants into controlled BP, white-coat, masked, and sustained hypertension on the basis of clinic and 24-hour ambulatory BP. We obtained echocardiograms and measured pulse wave velocity in 1278 and 1394 participants, respectively.RESULTS: The percentages of participants with controlled BP, white-coat, masked, and sustained hypertension were 49.3{\%}, 4.1{\%}, 27.8{\%}, and 18.8{\%}, respectively. Compared with controlled BP, masked hypertension independently associated with low eGFR (-3.2 ml/min per 1.73 m(2); 95{\%} confidence interval, -5.5 to -0.9), higher proteinuria (+0.9 unit higher in log2 urine protein; 95{\%} confidence interval, 0.7 to 1.1), and higher left ventricular mass index (+2.52 g/m(2.7); 95{\%} confidence interval, 0.9 to 4.1), and pulse wave velocity (+0.92 m/s; 95{\%} confidence interval, 0.5 to 1.3). Participants with masked hypertension had lower eGFR only in the presence of elevated nighttime BP (-3.6 ml/min per 1.73 m(2); 95{\%} confidence interval, -6.1 to -1.1; versus -1.4 ml/min per 1.73 m(2); 95{\%} confidence interval, -6.9 to 4.0, among those with nighttime BP <120/70 mmHg; P value for interaction with nighttime systolic BP 0.002).CONCLUSIONS: Masked hypertension is common in patients with CKD and associated with lower eGFR, proteinuria, and cardiovascular target organ damage. In patients with CKD, ambulatory BP characterizes the relationship between BP and target organ damage better than BP measured in the clinic alone.",
keywords = "ambulatory blood pressure monitoring, blood pressure, cardiovascular disease, chronic kidney disease, humans, hypertension, left ventricular hypertrophy, masked hypertension, nighttime, pulse wave analysis",
author = "{Chronic Renal Insufficiency Cohort Study Investigators} and Drawz, {Paul E.} and Alper, {Arnold B.} and Anderson, {Amanda H.} and Brecklin, {Carolyn S.} and Charleston, {Jeanne B} and Jing Chen and Rajat Deo and Fischer, {Michael J.} and Jiang He and Hsu, {Chi Yuan} and Yonghong Huan and Keane, {Martin G.} and Kusek, {John W.} and Makos, {Gail K.} and Miller, {Edgar R} and Soliman, {Elsayed Z.} and Steigerwalt, {Susan P.} and Taliercio, {Jonathan J.} and Townsend, {Raymond R.} and Weir, {Matthew R.} and Wright, {Jackson T.} and Dawei Xie and Lawrence Appel",
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TY - JOUR

T1 - Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

T2 - Prevalence and Association with Target Organ Damage

AU - Chronic Renal Insufficiency Cohort Study Investigators

AU - Drawz, Paul E.

AU - Alper, Arnold B.

AU - Anderson, Amanda H.

AU - Brecklin, Carolyn S.

AU - Charleston, Jeanne B

AU - Chen, Jing

AU - Deo, Rajat

AU - Fischer, Michael J.

AU - He, Jiang

AU - Hsu, Chi Yuan

AU - Huan, Yonghong

AU - Keane, Martin G.

AU - Kusek, John W.

AU - Makos, Gail K.

AU - Miller, Edgar R

AU - Soliman, Elsayed Z.

AU - Steigerwalt, Susan P.

AU - Taliercio, Jonathan J.

AU - Townsend, Raymond R.

AU - Weir, Matthew R.

AU - Wright, Jackson T.

AU - Xie, Dawei

AU - Appel, Lawrence

PY - 2016/4/7

Y1 - 2016/4/7

N2 - BACKGROUND AND OBJECTIVES: Masked hypertension and elevated nighttime BP are associated with increased risk of hypertensive target organ damage and adverse cardiovascular and renal outcomes in patients with normal kidney function. The significance of masked hypertension for these risks in patients with CKD is less well defined. The objective of this study was to evaluate the association between masked hypertension and kidney function and markers of cardiovascular target organ damage, and to determine whether this relationship was consistent among those with and without elevated nighttime BP.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a cross-sectional study. We performed 24-hour ambulatory BP in 1492 men and women with CKD enrolled in the Chronic Renal Insufficiency Cohort Study. We categorized participants into controlled BP, white-coat, masked, and sustained hypertension on the basis of clinic and 24-hour ambulatory BP. We obtained echocardiograms and measured pulse wave velocity in 1278 and 1394 participants, respectively.RESULTS: The percentages of participants with controlled BP, white-coat, masked, and sustained hypertension were 49.3%, 4.1%, 27.8%, and 18.8%, respectively. Compared with controlled BP, masked hypertension independently associated with low eGFR (-3.2 ml/min per 1.73 m(2); 95% confidence interval, -5.5 to -0.9), higher proteinuria (+0.9 unit higher in log2 urine protein; 95% confidence interval, 0.7 to 1.1), and higher left ventricular mass index (+2.52 g/m(2.7); 95% confidence interval, 0.9 to 4.1), and pulse wave velocity (+0.92 m/s; 95% confidence interval, 0.5 to 1.3). Participants with masked hypertension had lower eGFR only in the presence of elevated nighttime BP (-3.6 ml/min per 1.73 m(2); 95% confidence interval, -6.1 to -1.1; versus -1.4 ml/min per 1.73 m(2); 95% confidence interval, -6.9 to 4.0, among those with nighttime BP <120/70 mmHg; P value for interaction with nighttime systolic BP 0.002).CONCLUSIONS: Masked hypertension is common in patients with CKD and associated with lower eGFR, proteinuria, and cardiovascular target organ damage. In patients with CKD, ambulatory BP characterizes the relationship between BP and target organ damage better than BP measured in the clinic alone.

AB - BACKGROUND AND OBJECTIVES: Masked hypertension and elevated nighttime BP are associated with increased risk of hypertensive target organ damage and adverse cardiovascular and renal outcomes in patients with normal kidney function. The significance of masked hypertension for these risks in patients with CKD is less well defined. The objective of this study was to evaluate the association between masked hypertension and kidney function and markers of cardiovascular target organ damage, and to determine whether this relationship was consistent among those with and without elevated nighttime BP.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a cross-sectional study. We performed 24-hour ambulatory BP in 1492 men and women with CKD enrolled in the Chronic Renal Insufficiency Cohort Study. We categorized participants into controlled BP, white-coat, masked, and sustained hypertension on the basis of clinic and 24-hour ambulatory BP. We obtained echocardiograms and measured pulse wave velocity in 1278 and 1394 participants, respectively.RESULTS: The percentages of participants with controlled BP, white-coat, masked, and sustained hypertension were 49.3%, 4.1%, 27.8%, and 18.8%, respectively. Compared with controlled BP, masked hypertension independently associated with low eGFR (-3.2 ml/min per 1.73 m(2); 95% confidence interval, -5.5 to -0.9), higher proteinuria (+0.9 unit higher in log2 urine protein; 95% confidence interval, 0.7 to 1.1), and higher left ventricular mass index (+2.52 g/m(2.7); 95% confidence interval, 0.9 to 4.1), and pulse wave velocity (+0.92 m/s; 95% confidence interval, 0.5 to 1.3). Participants with masked hypertension had lower eGFR only in the presence of elevated nighttime BP (-3.6 ml/min per 1.73 m(2); 95% confidence interval, -6.1 to -1.1; versus -1.4 ml/min per 1.73 m(2); 95% confidence interval, -6.9 to 4.0, among those with nighttime BP <120/70 mmHg; P value for interaction with nighttime systolic BP 0.002).CONCLUSIONS: Masked hypertension is common in patients with CKD and associated with lower eGFR, proteinuria, and cardiovascular target organ damage. In patients with CKD, ambulatory BP characterizes the relationship between BP and target organ damage better than BP measured in the clinic alone.

KW - ambulatory blood pressure monitoring

KW - blood pressure

KW - cardiovascular disease

KW - chronic kidney disease

KW - humans

KW - hypertension

KW - left ventricular hypertrophy

KW - masked hypertension

KW - nighttime

KW - pulse wave analysis

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