Novel Abpm Parameters and Blood Pressure Phenotypes in CKD

Objective: Our study aims to compare novel ABPM parameters between CKD and non-CKD patients and also within various subgroups of CKD. Design and method: 100 consecutive hypertensive patients-{Group A with CKD Stage 1 to 4 (n=50) and Group B - without CKD (n=50)}; underwent measurement of single clinic BP (SOBP, by Omron 7113), averaged automated clinic BP (AOBP, by Omron HEM 907) and 24 hours ABPM (by SunTech Oscar 2). Results: When compared with daytime ABPM, mean AOBP (136.8/78.5 mm Hg) correlated significantly better than mean single clinic BP (141.2/81.6 mm Hg); (r=0.75 versus 0.59). Group A had significantly higher (p<0.05) awake, asleep and 24 hour mean systolic BP {144.8, 133.4, 141.9} than Group B {139.6, 125.3, 136.7 mm Hg respectively}. Group A had significantly higher (p=0.03) masked hypertension (38% vs. 20% in Group B). Group A had EMBS (36% vs. 22%, p=0.04) and higher non dipping of BP (60% vs. 46%, p=0.04) as well as nocturnal heart rate (14% vs. 12%, p=0.06) than Group B. BP variability was significantly higher (p<0.05) in Group A (Average real variability: 12.9+4.18 vs. 11.6+3.63; Variability independent of the mean: 24.74+16.25 vs. 22.2+13.3). Conclusions: As compared to non-CKD population, CKD patients have higher prevalence of ABPM phenotypes such as masked hypertension, nocturnal hypertension, EMBS and BP variability irrespective of age, stage of CKD and level of control of office BP. Utilization of novel ABPM parameters can guide towards holistic management of hypertension in CKD.