Assessment of achieved clinic and ambulatory blood pressure recordings and outcomes during treatment in hypertensive patients with CKD

A multicenter prospective cohort study

Roberto Minutolo, Francis B. Gabbai, Rajiv Agarwal, Paolo Chiodini, Silvio Borrelli, Vincenzo Bellizzi, Felice Nappi, Giovanna Stanzione, Giuseppe Conte, Luca De Nicola

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Background We investigated the effect of having clinic and/or ambulatory blood pressures (BPs) not at goal on cardiorenal risk in patients with non-dialysis-dependent chronic kidney disease (CKD).

Study Design Multicenter prospective study.

Setting & Participants 489 consecutive hypertensive patients with CKD (stages 1-5) with concomitant assessment of ambulatory and clinic BPs followed up in tertiary nephrology clinics.

Predictors Achievement of goal for ambulatory (day- and night-time BPs < 135/85 and <120/70 mm Hg, respectively) and clinic (<140/90 mm Hg) BPs was used to create 4 BP groups: clinic and ambulatory BPs at goal (group 1), clinic BP above goal and ambulatory BP at goal (group 2), clinic BP at goal and ambulatory BP above goal (group 3), and clinic and ambulatory BPs above goal (group 4).

Outcomes Composite cardiovascular event outcome (fatal and nonfatal myocardial infarction, congestive heart failure, stroke, revascularization, peripheral vascular disease, and nontraumatic amputation) and a composite renal outcome (maintenance dialysis therapy or death).

Measurements Clinic and 24-hour ambulatory BPs.

Results Mean age was 64.4 ± 14.2 (SD) years; 41% were women, and diabetes and previous cardiovascular disease were present in 36% and 30%, respectively. Groups 1-4 contained 16.8%, 22.1%, 14.5%, and 46.6%, respectively, of the overall number of participants. Median follow-up was 5.2 years. Compared to group 1, the adjusted risk of the composite cardiovascular outcome was higher in groups 3 (HR, 3.17; 95% CI, 1.50-6.69) and 4 (HR, 2.83; 95% CI, 1.50-5.34), but not in group 2 (HR, 1.55; 95% CI, 0.75-3.19). Similarly, the risk of the composite renal outcome was higher in groups 3 (HR, 3.59; 95% CI, 2.05-6.27) and 4 (HR, 2.96; 95% CI, 1.83-4.78), but not group 2 (HR, 1.24; 95% CI, 0.67-2.27). Sensitivity analyses confirmed that these results were independent from the thresholds used for defining groups.

Limitations Only white patients were enrolled. Observational design does not allow for causality to be established.

Conclusions In patients with treated CKD, clinic BP above goal and ambulatory BP at goal identify a low-risk condition, whereas clinic BP at goal and ambulatory BP above goal are associated with higher cardiorenal risk, similar to that observed in patients with both clinic and ambulatory BPs above goal.

Original languageEnglish
Pages (from-to)744-752
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume64
Issue number5
DOIs
StatePublished - Nov 1 2014

Fingerprint

Chronic Renal Insufficiency
Cohort Studies
Prospective Studies
Blood Pressure
Kidney
Fatal Outcome
Nephrology
Peripheral Vascular Diseases
Blood Group Antigens
Amputation
Causality
Multicenter Studies
Dialysis

Keywords

  • ambulatory blood pressure (BP)
  • blood pressure control
  • blood pressure goal
  • cardiorenal risk
  • clinic blood pressure
  • Index Words Chronic kidney disease (CKD)
  • masked hypertension
  • white coat hypertension

ASJC Scopus subject areas

  • Nephrology
  • Medicine(all)

Cite this

Assessment of achieved clinic and ambulatory blood pressure recordings and outcomes during treatment in hypertensive patients with CKD : A multicenter prospective cohort study. / Minutolo, Roberto; Gabbai, Francis B.; Agarwal, Rajiv; Chiodini, Paolo; Borrelli, Silvio; Bellizzi, Vincenzo; Nappi, Felice; Stanzione, Giovanna; Conte, Giuseppe; De Nicola, Luca.

In: American Journal of Kidney Diseases, Vol. 64, No. 5, 01.11.2014, p. 744-752.

Research output: Contribution to journalArticle

Minutolo, Roberto ; Gabbai, Francis B. ; Agarwal, Rajiv ; Chiodini, Paolo ; Borrelli, Silvio ; Bellizzi, Vincenzo ; Nappi, Felice ; Stanzione, Giovanna ; Conte, Giuseppe ; De Nicola, Luca. / Assessment of achieved clinic and ambulatory blood pressure recordings and outcomes during treatment in hypertensive patients with CKD : A multicenter prospective cohort study. In: American Journal of Kidney Diseases. 2014 ; Vol. 64, No. 5. pp. 744-752.
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TY - JOUR

T1 - Assessment of achieved clinic and ambulatory blood pressure recordings and outcomes during treatment in hypertensive patients with CKD

T2 - A multicenter prospective cohort study

AU - Minutolo, Roberto

AU - Gabbai, Francis B.

AU - Agarwal, Rajiv

AU - Chiodini, Paolo

AU - Borrelli, Silvio

AU - Bellizzi, Vincenzo

AU - Nappi, Felice

AU - Stanzione, Giovanna

AU - Conte, Giuseppe

AU - De Nicola, Luca

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Background We investigated the effect of having clinic and/or ambulatory blood pressures (BPs) not at goal on cardiorenal risk in patients with non-dialysis-dependent chronic kidney disease (CKD).Study Design Multicenter prospective study.Setting & Participants 489 consecutive hypertensive patients with CKD (stages 1-5) with concomitant assessment of ambulatory and clinic BPs followed up in tertiary nephrology clinics.Predictors Achievement of goal for ambulatory (day- and night-time BPs < 135/85 and <120/70 mm Hg, respectively) and clinic (<140/90 mm Hg) BPs was used to create 4 BP groups: clinic and ambulatory BPs at goal (group 1), clinic BP above goal and ambulatory BP at goal (group 2), clinic BP at goal and ambulatory BP above goal (group 3), and clinic and ambulatory BPs above goal (group 4).Outcomes Composite cardiovascular event outcome (fatal and nonfatal myocardial infarction, congestive heart failure, stroke, revascularization, peripheral vascular disease, and nontraumatic amputation) and a composite renal outcome (maintenance dialysis therapy or death).Measurements Clinic and 24-hour ambulatory BPs.Results Mean age was 64.4 ± 14.2 (SD) years; 41% were women, and diabetes and previous cardiovascular disease were present in 36% and 30%, respectively. Groups 1-4 contained 16.8%, 22.1%, 14.5%, and 46.6%, respectively, of the overall number of participants. Median follow-up was 5.2 years. Compared to group 1, the adjusted risk of the composite cardiovascular outcome was higher in groups 3 (HR, 3.17; 95% CI, 1.50-6.69) and 4 (HR, 2.83; 95% CI, 1.50-5.34), but not in group 2 (HR, 1.55; 95% CI, 0.75-3.19). Similarly, the risk of the composite renal outcome was higher in groups 3 (HR, 3.59; 95% CI, 2.05-6.27) and 4 (HR, 2.96; 95% CI, 1.83-4.78), but not group 2 (HR, 1.24; 95% CI, 0.67-2.27). Sensitivity analyses confirmed that these results were independent from the thresholds used for defining groups.Limitations Only white patients were enrolled. Observational design does not allow for causality to be established.Conclusions In patients with treated CKD, clinic BP above goal and ambulatory BP at goal identify a low-risk condition, whereas clinic BP at goal and ambulatory BP above goal are associated with higher cardiorenal risk, similar to that observed in patients with both clinic and ambulatory BPs above goal.

AB - Background We investigated the effect of having clinic and/or ambulatory blood pressures (BPs) not at goal on cardiorenal risk in patients with non-dialysis-dependent chronic kidney disease (CKD).Study Design Multicenter prospective study.Setting & Participants 489 consecutive hypertensive patients with CKD (stages 1-5) with concomitant assessment of ambulatory and clinic BPs followed up in tertiary nephrology clinics.Predictors Achievement of goal for ambulatory (day- and night-time BPs < 135/85 and <120/70 mm Hg, respectively) and clinic (<140/90 mm Hg) BPs was used to create 4 BP groups: clinic and ambulatory BPs at goal (group 1), clinic BP above goal and ambulatory BP at goal (group 2), clinic BP at goal and ambulatory BP above goal (group 3), and clinic and ambulatory BPs above goal (group 4).Outcomes Composite cardiovascular event outcome (fatal and nonfatal myocardial infarction, congestive heart failure, stroke, revascularization, peripheral vascular disease, and nontraumatic amputation) and a composite renal outcome (maintenance dialysis therapy or death).Measurements Clinic and 24-hour ambulatory BPs.Results Mean age was 64.4 ± 14.2 (SD) years; 41% were women, and diabetes and previous cardiovascular disease were present in 36% and 30%, respectively. Groups 1-4 contained 16.8%, 22.1%, 14.5%, and 46.6%, respectively, of the overall number of participants. Median follow-up was 5.2 years. Compared to group 1, the adjusted risk of the composite cardiovascular outcome was higher in groups 3 (HR, 3.17; 95% CI, 1.50-6.69) and 4 (HR, 2.83; 95% CI, 1.50-5.34), but not in group 2 (HR, 1.55; 95% CI, 0.75-3.19). Similarly, the risk of the composite renal outcome was higher in groups 3 (HR, 3.59; 95% CI, 2.05-6.27) and 4 (HR, 2.96; 95% CI, 1.83-4.78), but not group 2 (HR, 1.24; 95% CI, 0.67-2.27). Sensitivity analyses confirmed that these results were independent from the thresholds used for defining groups.Limitations Only white patients were enrolled. Observational design does not allow for causality to be established.Conclusions In patients with treated CKD, clinic BP above goal and ambulatory BP at goal identify a low-risk condition, whereas clinic BP at goal and ambulatory BP above goal are associated with higher cardiorenal risk, similar to that observed in patients with both clinic and ambulatory BPs above goal.

KW - ambulatory blood pressure (BP)

KW - blood pressure control

KW - blood pressure goal

KW - cardiorenal risk

KW - clinic blood pressure

KW - Index Words Chronic kidney disease (CKD)

KW - masked hypertension

KW - white coat hypertension

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