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Abstract: ASN Annual Meeting -- San Francisco |
Pogue V, Rahman M, Phillips R, et al.
High Prevalence of Masked Hypertension in Treated Hypertensive Nephrosclerosis: Results from the AASK Cohort Study.
ASN Annual Meeting -- San Francisco
J Am Soc Nephrol (Nov) 18:632A 2007
Background: The AASK trial and others studies have shown that hypertensive CKD progresses despite well-controlled clinic BP. However, clinic BP may not reflect daytime or nighttime BP, which may be more important determinants of BP-related end-organ damage than clinic BP.
Objective: To determine the concordance between clinic and ABPM in participants in the AASK Cohort Study.
Methods: ABPM was obtained in 617 hypertensive African- Americans with CKD at baseline in the AASK Cohort Study, an extension of the AASK trial. Daytime BP was the average BP between 06:01 to 24:00; nighttime BP was the average between 00:01-06:00. Uncontrolled BP was defined as follows: clinic BP >140/90, daytime ABPM >135/85, and nighttime ABPM >120/70.
Results: Mean clinic SBP was 134 + 19.8 and DBP 79.9 + 11.8. When control status by clinic and ABPM were compared (table), there was concordance in 338 (54.8%) and discordance in 279 (45.2%). In those with controlled clinic BP, 70.3% had elevated daytime or nighttime BP (i.e. masked hypertension). Abnormal diurnal BP patterns [non-dipping (41%) and nighttime increases (reverse dipping) (39%)] were more common than dipping (19.8%). In 157 of the 377 controlled by clinic (41.6%), nighttime BP was higher than day BP.
Conclusion: The majority of AASK cohort participants with controlled clinic BP have masked hypertension. These data, in conjunction with results from other studies, provide a compelling rationale to initiate trials that test whether reducing nocturnal BP can prevent CKD progression and other BP-related morbidity.
Comparison of BP status by clinic and ABP measurements Controlled Clinic BP (N=377) Uncontrolled Clinic BP (N=240) Daytime BP N (%) N (%) controlled 222 (58.9%) 33 (13.8%) uncontrolled 155 (41.1%) 207 (86.3%) nighttime BP controlled 127 (33.7%) 23 (9.6%) uncontrolled 250 (66.3%) 217 (90.4%) Day or Nighttime BP Both controlled 112 (29.7%) 14 (5.8%) Either uncontrolled 265 (70.3%) 226 (94.2%)
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