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Clin J Am Soc Nephrol. 2018 Sep 7;13(9):1348-1357. doi: 10.2215/CJN.13181117. Epub 2018 Jul 5.

Variations in 24-Hour BP Profiles in Cohorts of Patients with Kidney Disease around the World: The I-DARE Study.

Author information

1
Divisions of Renal Diseases and Hypertension and draw0003@umn.edu.
2
Biostatistics, University of Minnesota, Minneapolis, Minnesota.
3
Division of Nephrology, University of Campania L. Vanvitelli, Naples, Italy.
4
Nephrology Unit, Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan.
5
Division of Nephrology-Hypertension, VA San Diego Healthcare System and University of California, San Diego, California.
6
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
7
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
8
Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan.
9
Department of Medicine, University of Illinois Chicago, Chicago, Illinois.
10
Department of Cardiology, Houston Methodist, Houston, Texas.
11
Weill Cornell Medical College, New York, New York.
12
Department of Internal Medicine, Hypertension Unit and Institute of Research, Hospital 12 de Octubre, Madrid, Spain.
13
Department Preventive Medicine and Public Health, Universidad Autonoma, Madrid, Spain.
14
School of Doctoral Studies and Research, Universidad Europea, Madrid, Spain.
15
Department of Medicine, Universidad Europea, Ann Arbor, Michigan.
16
Renal, Electrolyte and Hypertension Division and.
17
Department of Biostatistics, Epidemiology and Informatics and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
18
Department of Medicine, Case Western University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.

Abstract

BACKGROUND AND OBJECTIVES:

Ambulatory BP is increasingly recognized as a better measure of the risk for adverse outcomes related to hypertension, an important comorbidity in patients with CKD. Varying definitions of white-coat and masked hypertension have made it difficult to evaluate differences in prevalence of these BP patterns across CKD cohorts.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

The International Database of Ambulatory BP in Renal Patients collaborative group established a large database of demographic, clinical, and ambulatory BP data from patients with CKD from cohorts in Italy, Spain, the Chronic Renal Insufficiency Cohort (CRIC) and the African American Study of Kidney Disease and Hypertension Cohort Study (AASK) in the United States, and the CKD Japan Cohort (CKD-JAC). Participants (n=7518) with CKD were included in the present analyses. Cutoffs for defining controlled BP were 140/90 mm Hg for clinic and 130/80 mm Hg for 24-hour ambulatory BP.

RESULTS:

Among those with controlled clinic BP, compared with CKD-JAC, AASK participants were more likely to have masked hypertension (prevalence ratio [PR], 1.21; 95% confidence interval [95% CI], 1.04 to 1.41) whereas CRIC (PR, 0.82; 0.72 to 0.94), Italian (PR, 0.73; 0.56 to 0.95), and Spanish participants (PR, 0.75; 0.64 to 0.88) were less likely. Among those with elevated clinic BP, AASK participants were more likely to have sustained hypertension (PR, 1.22; 95% CI, 1.13 to 1.32) whereas Italian (PR, 0.78; 0.70 to 0.87) and Spanish participants (PR, 0.89; 0.82 to 0.96) were less likely, although CRIC participants had similar prevalence as CKD-JAC. Prevalence of masked and sustained hypertension was elevated in males, patients with diabetes, participants on four or more antihypertensives, and those with moderate-to-severe proteinuria.

CONCLUSIONS:

In a large, multinational database, the prevalence of masked and sustained hypertension varied across cohorts independent of important comorbidities.

KEYWORDS:

Antihypertensive Agents; Blood Pressure Monitoring, Ambulatory; Cohort Studies; Comorbidity; Masked Hypertension; Prevalence; Renal Insufficiency, Chronic; White Coat Hypertension; blood pressure; chronic kidney disease; diabetes mellitus; ethnicity; hypertension; kidney; proteinuria

PMID:
29976600
PMCID:
PMC6140571
[Available on 2019-09-07]
DOI:
10.2215/CJN.13181117

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