Out-of-clinic blood pressure measurements are recommended in recent guidelines. Stanford E. Mwasongwe, MPH, MDiv, and colleagues performed an analysis to compare the prevalence of blood pressure phenotypes between 51 black patients, with and without chronic kidney disease (CKD), taking antihypertensive medications. Patients who underwent ambulatory blood pressure monitoring at baseline (between 2000 and 2004) in the Jackson Heart Study were eligible.
CKD was defined as an albumin-to-creatinine ratio ≥30 mg/g or estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m2. Sustained controlled blood pressure was defined by blood pressure goal both inside and outside the clinic, and sustained uncontrolled blood pressure was defined as blood pressure above goal both inside and outside of the clinic. Masked uncontrolled hypertension was defined by controlled clinic-measured blood pressure with uncontrolled out-of-clinic blood pressure.
There was an association between CKD and a higher multivariable-adjusted prevalence ratio for uncontrolled versus controlled clinic blood pressure (prevalence ratio, 1.44; 95% confidence interval [CI], 1.02-2.02) and sustained uncontrolled blood pressure versus sustained controlled blood pressure (prevalence ratio, 1.66; 95% CI, 1.16-2.36). Following multivariable adjustment, there were no statistically significant differences between the group with CKD and the group without CKD in the prevalence of uncontrolled daytime or nighttime blood pressure, nondipping blood pressure, white-coat effect, and masked uncontrolled hypertension.
There was an association between reduced eGFR and masked uncontrolled hypertension versus sustained controlled blood pressure (prevalence ratio, 1.42; 95% CI, 1.00-2.00). There was an association between albuminuria and uncontrolled clinic blood pressure (prevalence ratio, 1.76; 95% CI, 1.20-2.60) and sustained uncontrolled blood pressure versus sustained controlled blood pressure (prevalence ratio, 2.02; 95% CI, 1.36-2.99).
In summary, the authors said, “The prevalence of blood pressure phenotypes defined using ambulatory blood pressure monitoring is high among adults taking antihypertensive medication.”
Clinical Journal of the American Society of Nephrology. 2020;15(4):501-510