Abstract
BackgroundHypertension plays a key role in chronic kidney disease (CKD), but CKD itself affects the blood pressure (BP) profile. The aim of this study was to assess the association of BP profile with CKD and the presence of cardiac organ damage.MethodsWe studied 1805 patients, referred to our Hypertension Centre, in whom ABPM, blood tests, and echocardiography were clinically indicated. The glomerular filtration rate was estimated (eGFR) using the MDRD equation and CKD was defined as eGFR<60 mL/min/1.73 m2. Cardiac organ damage was evaluated by echocardiography.ResultsAmong patients with CKD there were higher systolic blood pressure (SBP) during the night-time, greater prevalence of non-dippers (OR: 1.8) and increased pulse pressure (PP) during 24-hour period, daytime and night-time (all p<0.001). Patients with CKD had a greater LVM/h2.7 index, and a higher prevalence of left ventricular hypertrophy and diastolic dysfunction (all p<0.001). Nocturnal SBP and PP correlated more strongly with cardiac organ damage (p<0.001). Patients with CKD had a greater Treatment Intensity Score (p<0.001) in the absence of a significantly greater BP control.ConclusionsCKD patients have an altered night-time pressure profile and higher PP that translate into a more severe cardiac organ damage. In spite of a greater intensity of treatment in most patients with CKD, BP control was similar to patients without CKD. Our findings indicate the need of a better antihypertensive therapy in CKD, better selected drugs, dosages and posology to provide optimal coverage of 24 hours and night-time BP.
Highlights
Chronic kidney disease (CKD) is a major health problem and its prevalence is increasing worldwide [1]
Our study shows that patients with a reduced estimated glomerular filtration rate (eGFR) (,60 ml/ min/1.73 m2) had an altered 24-hour blood pressure (BP) profile, especially at
Higher night-time systolic blood pressure (SBP), a more frequent non-dipper pattern and higher pulse pressure (PP) are related with more severe cardiac organ damage
Summary
Chronic kidney disease (CKD) is a major health problem and its prevalence is increasing worldwide [1]. A GFR lower than 60 mL/min/1.73 m2 for 3 months indicates CKD, regardless of the presence or absence of kidney damage [2]. High blood pressure (BP) can be either a cause or a consequence of CKD [2]. Considering the role of BP in diabetes, high BP is believed to be the leading cause of end-stage renal disease (ESRD). A recent study shows that even pre-hypertension is significantly associated with an increased risk of CKD and it can be considered one of the relevant causes of CKD in the general population because of its high frequency [7]. Hypertension plays a key role in chronic kidney disease (CKD), but CKD itself affects the blood pressure (BP) profile. The aim of this study was to assess the association of BP profile with CKD and the presence of cardiac organ damage
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