Hypertension diagnosis and prognosis in chronic kidney disease with out-of-office blood pressure monitoring

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Purpose of review: Hypertension is an important risk factor for adverse cardiovascular and renal outcomes particularly in patients with chronic kidney disease. This review compares blood pressure measurements obtained in the clinic with those obtained outside the clinic to predict cardiovascular and renal injury and outcomes. Recent findings: When home blood pressure monitoring (self-measured blood pressure) is performed, hypertension is less frequently misclassified and better correlation is achieved with putative markers of kidney disease progression. Masked hypertension - normotension in the clinic, hypertension at home - is associated with higher risk of end-stage renal disease in patients with chronic kidney disease. Conversely, 'white coat' hypertension - hypertension in the clinic and normotension at home - is associated with better renal outcomes. Ambulatory blood pressure monitoring is also prognostically superior to clinic blood pressure but does not further refine the prognosis made by home blood pressure monitoring. In patients on hemodialysis, home blood pressure, not predialysis and postdialysis blood pressure, shares the combination of high sensitivity and high specificity of greater than 80% to make a diagnosis of hypertension with the reference standard of ambulatory blood pressure monitoring. In addition, home blood pressure is a better correlate of left ventricular hypertrophy in patients on hemodialysis compared with peridialysis blood pressure. Summary: Home blood pressure monitoring should be an essential part of management of hypertension in patients with all stages of chronic kidney disease.

Original languageEnglish
Pages (from-to)309-313
Number of pages5
JournalCurrent Opinion in Nephrology and Hypertension
Volume15
Issue number3
DOIs
StatePublished - May 2006

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Chronic Renal Insufficiency
Ambulatory Blood Pressure Monitoring
Blood Pressure
Hypertension
Kidney
Masked Hypertension
Home Hemodialysis
White Coat Hypertension
Kidney Diseases
Left Ventricular Hypertrophy
Chronic Kidney Failure
Renal Dialysis
Disease Progression
Sensitivity and Specificity
Wounds and Injuries

Keywords

  • Ambulatory blood pressure monitoring
  • Cardiovascular disease
  • Chronic kidney disease
  • Home blood pressure monitoring
  • Hypertension

ASJC Scopus subject areas

  • Nephrology
  • Internal Medicine

Cite this

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abstract = "Purpose of review: Hypertension is an important risk factor for adverse cardiovascular and renal outcomes particularly in patients with chronic kidney disease. This review compares blood pressure measurements obtained in the clinic with those obtained outside the clinic to predict cardiovascular and renal injury and outcomes. Recent findings: When home blood pressure monitoring (self-measured blood pressure) is performed, hypertension is less frequently misclassified and better correlation is achieved with putative markers of kidney disease progression. Masked hypertension - normotension in the clinic, hypertension at home - is associated with higher risk of end-stage renal disease in patients with chronic kidney disease. Conversely, 'white coat' hypertension - hypertension in the clinic and normotension at home - is associated with better renal outcomes. Ambulatory blood pressure monitoring is also prognostically superior to clinic blood pressure but does not further refine the prognosis made by home blood pressure monitoring. In patients on hemodialysis, home blood pressure, not predialysis and postdialysis blood pressure, shares the combination of high sensitivity and high specificity of greater than 80{\%} to make a diagnosis of hypertension with the reference standard of ambulatory blood pressure monitoring. In addition, home blood pressure is a better correlate of left ventricular hypertrophy in patients on hemodialysis compared with peridialysis blood pressure. Summary: Home blood pressure monitoring should be an essential part of management of hypertension in patients with all stages of chronic kidney disease.",
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AB - Purpose of review: Hypertension is an important risk factor for adverse cardiovascular and renal outcomes particularly in patients with chronic kidney disease. This review compares blood pressure measurements obtained in the clinic with those obtained outside the clinic to predict cardiovascular and renal injury and outcomes. Recent findings: When home blood pressure monitoring (self-measured blood pressure) is performed, hypertension is less frequently misclassified and better correlation is achieved with putative markers of kidney disease progression. Masked hypertension - normotension in the clinic, hypertension at home - is associated with higher risk of end-stage renal disease in patients with chronic kidney disease. Conversely, 'white coat' hypertension - hypertension in the clinic and normotension at home - is associated with better renal outcomes. Ambulatory blood pressure monitoring is also prognostically superior to clinic blood pressure but does not further refine the prognosis made by home blood pressure monitoring. In patients on hemodialysis, home blood pressure, not predialysis and postdialysis blood pressure, shares the combination of high sensitivity and high specificity of greater than 80% to make a diagnosis of hypertension with the reference standard of ambulatory blood pressure monitoring. In addition, home blood pressure is a better correlate of left ventricular hypertrophy in patients on hemodialysis compared with peridialysis blood pressure. Summary: Home blood pressure monitoring should be an essential part of management of hypertension in patients with all stages of chronic kidney disease.

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KW - Chronic kidney disease

KW - Home blood pressure monitoring

KW - Hypertension

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