Clinical correlates of ambulatory BP monitoring among patients with CKD

Clin J Am Soc Nephrol. 2013 May;8(5):721-30. doi: 10.2215/CJN.06470612. Epub 2013 Feb 14.


Background and objectives: Ambulatory BP monitoring (ABPM) allows a better risk stratification than office BP in hypertensive patients. However, the clinical relevance of ABPM has not been extensively investigated in the CKD population.

Design, setting, participants, & measurements: Within the Chronic Kidney Disease Japan Cohort study, 2977 patients enrolled (62% men, aged 60.8±11.6 years) and ABPM was conducted in a subgroup of patients from September 2007 to April 2010. Data from 1075 patients (682 men) were analyzed to determine BP control and factors associated with the ABPM parameters.

Results: The prevalence of masked hypertension was 30.9%, whereas that of white-coat hypertension was 5.6%. With advancing CKD stage, the percentage of persistent hypertension increased from 21.7% to 36.1%. Diabetes, antihypertensive medicine use, and low estimated GFR (eGFR) were significantly associated with the difference between office BP and ambulatory BP (1.7 mmHg, 2.6 mmHg, and 0.6 mmHg per 10 ml/min per 1.73 m(2), respectively). There tended to be fewer nondippers and risers in stage 3 than in stages 4 and 5. In the nocturia-negative group, low eGFR, diabetes, and summer season were identified as factors associated with lower nocturnal BP change (-0.5 mmHg, -2.0 mmHg, and -2.8 mmHg, respectively). Morning BP change was greater with older age (0.2 mmHg per 10 years) and higher body mass index (0.6 mmHg per 1 kg/m(2)), and in winter (4.5 mmHg) versus summer.

Conclusions: Various factors including eGFR, diabetes, antihypertensive medication use, and season are associated with higher BP and abnormal BP patterns in CKD patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure Monitoring, Ambulatory*
  • Blood Pressure* / drug effects
  • Chi-Square Distribution
  • Comorbidity
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Japan / epidemiology
  • Kidney / physiopathology
  • Linear Models
  • Male
  • Masked Hypertension / diagnosis*
  • Masked Hypertension / drug therapy
  • Masked Hypertension / epidemiology
  • Masked Hypertension / physiopathology
  • Middle Aged
  • Multivariate Analysis
  • Office Visits
  • Predictive Value of Tests
  • Prevalence
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / epidemiology*
  • Renal Insufficiency, Chronic / physiopathology
  • Risk Factors
  • Seasons
  • White Coat Hypertension / diagnosis*
  • White Coat Hypertension / drug therapy
  • White Coat Hypertension / epidemiology
  • White Coat Hypertension / physiopathology


  • Antihypertensive Agents