SPECIAL FEATURES OF HYPERTENSION IN CHRONIC RENAL DISEASE: WHAT WE LEARN FROM AMBULATORY BLOOD PRESSURE MEASUREMENT

Abstract

Objective: High blood pressure (hypertension) is frequently encountered in chronic kidney disease (CKD). Whether responsible for CKD or secondary, hypertension constitutes an important and modifiable risk factor in the course of CKD. The appropriate assessment of BP in CKD therefore becomes crucial to establish the diagnosis of hypertension and to consider appropriate therapies. Recent studies including ambulatory blood pressure measurement (ABPM) in CKD rather than office measurement allows early diagnosis of hypertension and identification of high risk patients Design and method: This is a prospective study carried out within the explorations unit, the objective of which was to assess the contribution of MAPA, its peculiarities and its prognostic elements in MRC. The study included two groups of hypertensive patients: a group of patients with stage 3, 4 and 5 CKD and a control group. CKD was defined according to the KDIGO classification, hypertension is defined is defined according to the French society of hypertension and the WHO In group 1. Results: the average age is 57.10 +/- 3.55 years vs. 51.28 +/- 9.36 years in group 2. In CKD the hypertension is older (6.34 +/- 6, 18 years vs. 4.71 +/- 4.37 years). Compared to group 2, the ABPM evaluation of hypertension associated with CKD highlights the unbalanced, severe nature with loss of physiological dipping. In multivariate analysis, CKD and male sex are the predictors of no dipping and nocturnal hypertension in group 1 Conclusions: Several studies highlight the peculiarities of hypertension in CKD. 6 to 50% of patients with CKD are non-dippers and 10 to 35% have nocturnal hypertension. These changes in BP are accompanied by cardiac and renal events in CKD. This underscores the value of continuous assessment of BP in patients with CKD.