Value of Morning Home Blood Pressure as a Predictor of Decline in Renal Function in Patients with Chronic Kidney Disease

Abstract

Although blood pressure (BP) control is significantly associated with progression of chronic kidney disease (CKD), the influence of BP control based on home BP (HBP) measurement on the change in renal function in CKD patients is not fully defined.We recruited 137 patients with stage 3-5 CKD, who performed daily HBP measurements continuously. HBP was measured every morning and evening and data were obtained every 6 months in each patient with a follow-up of 32 +/- 5 months. The associations between BP data, other clinical variables and the change in estimated glomerular filtration rate (eGFR) were examined.Mean morning BP, evening BP and clinic BP were 132.9/76.2, 128.5/72.5 and 129.4/69.1 mm Hg, respectively. There were significant correlations between mean morning systolic BP (SBP), mean evening SBP, mean clinic SBP and the change in eGFR (r = -0.318, -0.215, -0.174, p < 0.0001, <0.05, <0.05). Stepwise multivariate regression analysis demonstrated mean morning SBP and mean urinary protein excretion as independent predictors of the change in eGFR.Morning SBP is a more significant predictor of decline in renal function than evening SBP or clinic SBP.