Key result
Ambulatory blood pressure monitoring guided treatment did not significantly improve eGFR decline over 18 months compared to office BP monitoring (-5.5 vs -5.0 ml/min per 1.73 m2; P=0.704).
Why the study?
Adequate BP control is pivotal for managing CKD, but the optimal approach for monitoring BP to delay CKD progression remains unclear.
Does ABPM-guided antihypertensive treatment improve renal progression in patients with hypertension and CKD stage 3-4?
RCT (n=146)
Does ABPM-guided antihypertensive treatment improve renal progression in patients with hypertension and CKD stage 3-4?
Absolute Event Rate: -5.5% vs -5%
p-value: p=0.704
ABPM-guided antihypertensive treatment did not significantly improve renal outcomes compared to conventional office BP monitoring in patients with CKD stage 3-4.
ABPM-guided therapy does not slow eGFR decline versus office BP in hypertensive CKD stage 3-4; challenges routine preference for ambulatory monitoring to preserve renal function.
OBJECTIVES: Adequate blood pressure (BP) control is pivotal for managing chronic kidney disease (CKD). The optimal approach for monitoring BP to delay CKD progression is not yet clear. METHODS: Patients with hypertension and CKD stage 3-4 were randomized into ambulatory blood pressure monitoring (ABPM) or office BP groups. All patients had ABPM at baseline and 18 months, and the ABPM group additionally underwent ABPM at 3 and 6 months. Each ABPM result was notified only for the ABPM group. The BP target was daytime ABP less than 135/85 mmHg for the ABPM group and office BP less than 140/90 mmHg for the office BP group. The primary outcome was decrease in estimated glomerular filtration rate (eGFR) during 18 months. RESULTS: A total of 146 patients were randomized into the ABPM (n = 69) and office BP groups (n = 77). Although office BP was comparable in the two groups at baseline, daytime ABP was higher in the ABPM group (median 140 vs. 132 mmHg). Initial eGFR was 35.7 ± 12.5 ml/min per 1.73 m2 in the ABPM group and 34.6 ± 12.0 ml/min per 1.73 m2 in the office BP group. eGFR change was -5.5 [95% confidence interval (95% CI) -7.7 to -3.4] ml/min per 1.73 m2 in the ABPM group and -5.0 (95% CI -6.9 to -3.0) ml/min per 1.73 m2 in the office BP group (P = 0.704). Renal events occurred in 10 patients (15.6%) from the ABPM group and five (7.1%) from the office BP group (P = 0.120). CONCLUSION: The present study did not show a beneficial effect of ABPM for controlling hypertension in CKD compared with conventional office BP monitoring in terms of renal outcomes.
No takes yet. Share an insight, caveat, or question.
Kim et al. (2020) conducted an RCT in Hypertension and chronic kidney disease stage 3-4 (n=146). Ambulatory blood pressure monitoring (ABPM) vs. Office BP monitoring (target < 140/90 mmHg) was evaluated on Decrease in estimated glomerular filtration rate (eGFR) during 18 months (p=0.704). Ambulatory blood pressure monitoring guided treatment did not significantly improve eGFR decline over 18 months compared to office BP monitoring (-5.5 vs -5.0 ml/min per 1.73 m2; P=0.704).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: