Key result
Better blood pressure control and dipping status changes over 1 year were associated with more stable eGFR and proteinuria, and less cardio-cerebrovascular damage in 378 hypertensive CKD patients.
Observational (n=378)
Yes
In hypertensive patients with chronic kidney disease, masked and uncontrolled hypertension are highly prevalent, and improving blood pressure control and dipping patterns is associated with preserved renal function and reduced target organ damage.
OBJECTIVE: Blood pressure (BP) control is the most established practice for preventing the progression of chronic kidney disease (CKD). We examined the BP control and nocturnal dipping pattern changes in hypertensive patients with CKD and their effects on target organ damages. METHODS: We recruited 378 hypertensive CKD patients from four centers in Korea. The patients underwent clinic and ambulatory BP monitoring at the time of enrollment and 1 year later. RESULTS: The BP control states at the two time points were as follows: true controlled (16.5, 17.5%), white-coat (2.9, 0.4%), masked (50.0, 53.3%), and sustained uncontrolled (30.6, 28.8%) hypertension. The dipping states at two time points were as follows: extreme-dipping (11.4, 10.8%), dipping (22.2, 20.5%), nondipping (31.3, 34.7%), and reverse-dipping (35.0, 34.0%). When we divided the patients according to the median estimated glomerular filtration rate (eGFR) and proteinuria changes, more stable changes in eGFR and proteinuria were associated with better (to true controlled and white-coat) initial and follow-up BP control statuses. Moreover, better BP control and dipping (to dipper) changes were also associated with more stable eGFR and proteinuria changes. Good initial and follow-up BP control statuses were associated with less left ventricular hypertrophy. Also, masked and sustained uncontrolled hypertension was associated with more cardio-cerebrovascular events in the univariate analysis. CONCLUSIONS: A large majority of Korean hypertensive CKD patients had uncontrolled BP and abnormal dipping patterns. Furthermore, better BP control and dipping status changes were associated with better renal function and proteinuria, and also less cardio-cerebrovascular damages.
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Cha et al. (2016) conducted an observational in Hypertensive patients with chronic kidney disease (n=378). Blood pressure control and nocturnal dipping pattern changes vs. Poor blood pressure control and abnormal dipping patterns was evaluated on Target organ damages including eGFR, proteinuria, left ventricular hypertrophy, and cardio-cerebrovascular events. Better blood pressure control and dipping status changes over 1 year were associated with more stable eGFR and proteinuria, and less cardio-cerebrovascular damage in 378 hypertensive CKD patients.
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