Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease

Velvie Pogue, Mahboob Rahman, Michael Lipkowitz, Robert Toto, Edgar Miller, Marquetta Faulkner, Stephen Rostand, Leena Hiremath, Mohammed Sika, Cynthia Kendrick, Bo Hu, Tom Greene, Lawrence Appel, Robert A. Phillips

Research output: Contribution to journalArticle

190 Scopus citations

Abstract

Ambulatory blood pressure (ABP) monitoring provides unique information about day-night patterns of blood pressure (BP). The objectives of this article were to describe ABP patterns in African Americans with hypertensive kidney disease, to examine the joint distribution of clinic BP and ABP, and to determine associations of hypertensive target organ damage with clinic BP and ABP. This study is a cross-sectional analysis of baseline data from the African American Study of Kidney Disease Cohort Study. Masked hypertension was defined by elevated daytime (≥135/ 85 mm Hg) or elevated nighttime (≥120/70 mm Hg) ABP in those with controlled clinic BP (<140/90 mm Hg): nondipping was defined by a ≤10% decrease in mean nighttime systolic BP; reverse dipping was defined by a higher nighttime than daytime systolic BP. Of the 617 participants (mean age: 60.2 years; 62% male; mean estimated glomerular filtration rate: 43.8 mL/min per 1.73 m2) with both clinic BP and ABP, 498 participants (80%) had a nondipping or reverse dipping profile. Of the 377 participants with controlled clinic BP (61%), 70% had masked hypertension. Compared with those with controlled clinic BP or white-coat hypertension, target organ damage (proteinuria and left ventricular hypertrophy) was more common in those with elevated nighttime BP, masked hypertension, or sustained hypertension. In conclusion, clinic BP provides an incomplete and potentially misleading assessment of the severity of hypertension in African Americans with hypertensive kidney disease, in large part because of increased nighttime BP. Whether lowering nighttime BP improves clinical outcomes is unknown but should be tested given the substantial burden of BP-related morbidity in this population.

Original languageEnglish (US)
Pages (from-to)20-27
Number of pages8
JournalHypertension
Volume53
Issue number1
DOIs
Publication statusPublished - Jan 2009

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Keywords

  • African American
  • Blood pressure
  • Chronic kidney disease
  • Nighttime hypertension

ASJC Scopus subject areas

  • Internal Medicine

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