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Home blood pressure measurement as a systematic tool for clinical practice in CKD patients: a real-world picture.

Home blood pressure measurement as a systematic tool for clinical practice in CKD patients: a real-world picture.
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Cupisti A, Ghiadoni L, Zullo C, Marchini M, Varricchio E, Puntoni A, Giglio E, Meniconi O, Bruno MR, Egidi MF,


Cupisti A, Ghiadoni L, Zullo C, Marchini M, Varricchio E, Puntoni A, Giglio E, Meniconi O, Bruno MR, Egidi MF, (click to view)

Cupisti A, Ghiadoni L, Zullo C, Marchini M, Varricchio E, Puntoni A, Giglio E, Meniconi O, Bruno MR, Egidi MF,

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Panminerva medica 2017 11 22() doi 10.23736/S0031-0808.17.03336-5
Abstract
BACKGROUND
Arterial hypertension is very common in chronic kidney disease (CKD) patients and its prevalence increases with lowering estimated glomerular filtration rate (eGFR). Blood pressure (BP) control is a cornerstone in the treatment of CKD patients but still most treatment decisions are based on office BP measurement (OBPM). The aim of this cross-sectional, retrospective study is to investigate the prevalence of hypertension phenotypes in CKD patients and whether different home (HBPM) or OBPM are associated with a different CKD stage and cardiovascular comorbidities.

METHODS
We analyzed 560 consecutive patients (359 men, age 70±13 years), affected by stage 3-5ND CKD, who performed HBPM recording; OBPM during a single visit was also assessed. Uncontrolled hypertension was defined OBPM values >140/90 mmHg and HBPM values >135/85 mmHg, respectively.

RESULTS
Systolic and diastolic HBPM values were lower than OBPM values. A white coat effect (systolic BP +18± 12 mmHg) was detected in 62.5%, while a masked effect (systolic BP – 14± 10 mmHg) was detected in 22.7%. No relationship was found between BP differences and body weight, CKD stage, eGFR or with the presence of diabetes. Based on OBPM, 18.6 % of patients showed controlled systolic and diastolic BP, whereas 37.8% had sustained hypertension. White-coat hypertension was detected in 23.4% and Masked hypertension in 12.1%. The multiple logistic regression model showed that masked uncontrolled hypertensive patients showed a higher probability of having ischemic heart disease [OR 2.54 (1.02- 6.36)], while sustained hypertension was associated with an increased prevalence of stroke in comparison to normotensive or true control BP group [OR 4.72 (1.30-17.07)]. Age, gender, diabetes or CKD stage, were not different among the four hypertension phenotypes.

CONCLUSIONS
We observed a quite high rate of masked uncontrolled hypertension and of white coat hypertension in stage 3-5ND CKD patients. Office BP measurement, as a single tool, is an inadequate diagnostic procedure in the clinical management of CKD patients. HBPM should be routinely implemented for identifying hypertensive phenotypes and then for avoiding misdiagnosis and mistreatment of pre-dialysis CKD patients in a tertiary care setting.

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