Prevalence and factors associated with masked hypertension in chronic kidney disease

Objectives: Optimal blood pressure (BP) control is key to prevent cardiovascular complications in patients with chronic kidney disease (CKD). We described the prevalence and factors associated with masked hypertension in CKD. Methods: We analyzed 1113 ambulatory 24-h BP monitoring (ABPM) records of 632 patients referred for kidney function evaluation. Masked hypertension was defined as office BP less than 140/90 mmHg but daytime BP at least 135/85 mmHg or nighttime BP at least 120/70 mmHg. Factors associated with masked hypertension were assessed with mixed logistic regression models. Results: At inclusion, 424 patients (67%) had controlled office BP, of whom 56% had masked hypertension. In multivariable analysis conducted in all visits with controlled office BP ( n = 782), masked hypertension was positively associated with male sex adjusted OR (95% confidence interval) 1.91 (1.16–3.27), sub-Saharan African origin 2.51 (1.32–4.63), BMI 1.11 (1.01–1.17) per 1 kg/m 2 , and albuminuria 1.29 [1.12 - 1.47 per 1 log unit), and was negatively associated with plasma potassium (0.42 0.29 - 0.71 per 1 mmol/L) and 24-h urinary potassium excretion (0.91 0.82 - 0.99 per 10 mmol/24 h) as well as the use of renin-angiotensin-aldosterone (RAAS) blockers (0.56 0.31 - 0.97) and diuretics (0.41 0.27 - 0.72). Conclusion: Our findings support the routine use of ABPM in CKD, as more than half of the patients with controlled office BP had masked hypertension. Weight control, higher potassium intake (with caution in advanced CKD), correction of hypokalemia, and larger use of diuretics and RAAS blockers could be potential levers for better out-of-office BP control.