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

Rajiv Agarwal, M. J. Andersen

Research output: Contribution to journalArticle

129 Citations (Scopus)

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
Pages (from-to)406-411
Number of pages6
JournalKidney International
Volume69
Issue number2
DOIs
StatePublished - Jan 2006

Fingerprint

Chronic Renal Insufficiency
Blood Pressure
Chronic Kidney Failure
Confidence Intervals
Kidney
Veterans
Glomerular Filtration Rate
Proteinuria
Cohort Studies
Prospective Studies
Hypertension

Keywords

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

ASJC Scopus subject areas

  • Nephrology

Cite this

Prognostic importance of clinic and home blood pressure recordings in patients with chronic kidney disease. / Agarwal, Rajiv; Andersen, M. J.

In: Kidney International, Vol. 69, No. 2, 01.2006, p. 406-411.

Research output: Contribution to journalArticle

@article{67f015dd58544433b95a275ca3a0ce38,
title = "Prognostic importance of clinic and home blood pressure recordings in patients with chronic kidney disease",
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.",
keywords = "Chronic kidney disease, Clinic blood pressure, End-stage renal disease, Home blood pressure",
author = "Rajiv Agarwal and Andersen, {M. J.}",
year = "2006",
month = "1",
doi = "10.1038/sj.ki.5000081",
language = "English",
volume = "69",
pages = "406--411",
journal = "Kidney International",
issn = "0085-2538",
publisher = "Nature Publishing Group",
number = "2",

}

TY - JOUR

T1 - Prognostic importance of clinic and home blood pressure recordings in patients with chronic kidney disease

AU - Agarwal, Rajiv

AU - Andersen, M. J.

PY - 2006/1

Y1 - 2006/1

N2 - 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.

AB - 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.

KW - Chronic kidney disease

KW - Clinic blood pressure

KW - End-stage renal disease

KW - Home blood pressure

UR - http://www.scopus.com/inward/record.url?scp=33644649437&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33644649437&partnerID=8YFLogxK

U2 - 10.1038/sj.ki.5000081

DO - 10.1038/sj.ki.5000081

M3 - Article

C2 - 16408134

AN - SCOPUS:33644649437

VL - 69

SP - 406

EP - 411

JO - Kidney International

JF - Kidney International

SN - 0085-2538

IS - 2

ER -