Masked uncontrolled hypertension (MUCH) is diagnosed in patients treated for hypertension who are normotensive in the clinic but hypertensive outside. In this study of 333 veterans with CKD, we prospectively evaluated the prevalence of MUCH as determined by ambulatory BP monitoring using three definitions of hypertension (daytime hypertension 135/85 mmHg; either nighttime hypertension 120/70 mmHg or daytime hypertension; and 24-hour hypertension130/80mmHg)or byhomeBP monitoring (hypertension135/ 85mmHg). The prevalence ofMUCH was 26.7% by daytime ambulatory BP, 32.8% by 24-hour ambulatory BP, 56.1% by daytime or night-time ambulatory BP, and 50.8% by home BP. To assess the reproducibility of the diagnosis, we repeated these measurements after 4 weeks. Agreement in MUCH diagnosis by ambulatory BP was 75-78% (k coefficient for agreement, 0.44-0.51), depenDing on the definition used. In contrast, home BP showed an agreement of only 63% and a k coefficient of 0.25. Prevalence of MUCH increased with increasing clinic systolic BP: 2%in the 90-110mmHggroup,17%in the 110-119mmHggroup, 34%in the 120-129mmHg group, and 66% in the 130-139mmHg group. Clinic BP was a good determinant ofMUCH (receiver operating characteristic area under the curve 0.82; 95% confidence interval 0.76-0.87). In diagnosing MUCH, home BP was not different from clinic BP. In conclusion, among people with CKD, MUCH is common and reproducible, and should be suspected when clinic BP is in the prehypertensive range. Confirmation of MUCH diagnosis should rely on ambulatory BP monitoring.
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