Introduction:
Hypertension significantly contributes to the worsening of chronic kidney disease (CKD). It is prevalent in 86% of CKD patients, yet only a small fraction, about 13.2%, can effectively control their blood pressure (BP) to below 130/80 mm Hg. Current research indicates that assessing BP severity and control in CKD patients with only clinic BP measurements might be insufficient. Ambulatory BP monitoring (ABPM) offers a clearer picture of a patient's BP compared to clinic readings. A meta-analysis of six studies found that the occurrence of white-coat hypertension is 18.3%, and masked hypertension is 8.3% among CKD patients. The likely overestimation of uncontrolled hypertension in CKD patients due to prevalent white-coat hypertension is significant, especially among those with resistance. In the general population, 24-hour ABPM is established as an effective method for evaluating patients with resistant hypertension. However, its application in CKD patients, particularly for those with both CKD and resistant hypertension, is less documented in India.
Methods:
Patients older than 18 years were included in the study. Patients on Kidney replacement therapy - Dialysis or kidney transplant were excluded. Twenty-four-hour ABPM was conducted using a standard certified device after taking informed consent . The cuff size was chosen based on the patient's arm circumference. The BP monitoring took place on a typical workday while patients continue their regular antihypertensive medication. During the day, BP was measured every 30 minutes, and at night, every hour. Clinic BP measurements were taken by medical assistants trained in the standard protocol for BP measurement using an automated upper-arm BP device that is clinically approved .Bp was measured twice, and the average of these two readings was used.
Results:
Our study had 60 participants with the mean age of 59.3 years. 68 % were males. 73 % (44/60) had CKD and 51 % (31/60) had type 2 diabetes mellitus. 80% (25/31) patients with diabetes had CKD. The clinic systolic blood pressure (SBP) ranged from 108 - 210 mm hg and diastolic (DBP) 70- 130 mm Hg. The ABPM recordings showed a mean average BP, all day average Bp and night average BP to be lower than average clinic BP in all patients. The average maximum systolic BP was 175.5 mm hg and maximum diastolic average was 107.3 mm hg. The average minimum SBP was 111 and DBP was 60.4 mm hg. 16 % (10/60) had a dip in night SBP and 18 % (11 patients) had a dip in night DBP. 15 % (9/60) had a nocturnal dip in both SBP and DBP. 33% (20/60) who had an average clinic BP of >130/80 were diagnosed to have white coat hypertension. Only 15 % of these WCH patients had a nocturnal dip. One patient had isolated diastolic hypertension. None of our study participants had masked hypertension.
Conclusions:
The prevalence of WCH in our study was 33% which is significantly higher then estimated average of 18%. In patients with resistant hypertension and CKD, ABPM is an effective modality to re-assess, evaluate and treat hypertension. This may prevent over diagnosing and treating resistant hypertension.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.