Prognostic importance of clinic and home blood pressure recordings in patients with chronic kidney disease

R. Agarwal, M. J. Andersen

Research output: Contribution to journalArticle

132 Scopus citations

Abstract

Blood pressure (BP) measured only in the clinic substantially misclassifies hypertension in patients with chronic kidney disease (CKD). The role of out-of-clinic recordings of BP in predicting end-stage renal disease (ESRD) and death in patients with CKD is unknown. A prospective cohort study was conducted in 217 Veterans with CKD. BP was measured at home and in the clinic by 'routine' and standardized methods. Patients were followed over a median of 3.5 years to assess the end points of total mortality, ESRD or the composite outcome of ESRD or death. Home BP was 147.0±21.4/78.3±11.6 mmHg and clinic BPs were 155.2±25.6/84.7±14.2 mmHg by standardized method and 144.5±24.2/75.4±14.7 mmHg by the 'routine' method. The composite renal end point occurred in 75 patients (34.5%), death in 52 patients (24.0%), and ESRD in 36/178 patients (20.2%). One standard deviation (s.d.) increase in systolic BP increased the risk of renal end point by 1.27 (95% confidence interval (CI) 1.01-1.60) for routine clinic measurement, by 1.69 (95% CI 1.32-2.17) for standardized clinic measurement and by 1.84 (95% CI 1.46-2.32) for home BP recording. One s.d. increase in home systolic BP increased the risk of ESRD by 1.74 (95% CI 1.04-2.93) when adjusted for standardized clinic systolic BP, proteinuria, estimated glomerular filtration rate, and other risk factors. In patients with CKD, BPs obtained at home are a stronger predictor of ESRD or death compared to BPs obtained in the clinic. Systolic home BP is an independent predictor for ESRD.

Original languageEnglish (US)
Pages (from-to)406-411
Number of pages6
JournalKidney international
Volume69
Issue number2
DOIs
StatePublished - Jan 1 2006

Keywords

  • Chronic kidney disease
  • Clinic blood pressure
  • End-stage renal disease
  • Home blood pressure

ASJC Scopus subject areas

  • Nephrology

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