Journal Reading 4

Masked Hypertension and Elevated Nighttime Blood Pressure n CKD:

Prevalence and Association with Target Organ Damage
Paul E. Drawz, Arnold B. Alper, Amanda H. Anderson, et all
Journal of Diabetes Investigation 2015; 6; 360-366

Masked hypertension is defined as a normal blood pressure (BP) in the clinic or office
(<140/90 mmHg), but an elevated BP out of the clinic {ambulatory BP monitoring (AMPM
home BP>135/85 mmHg). It may occur in as many as 10% of the general population, and is
important because it is not diagnosed by routine medical examinations, but carries an adverse
prognosis, both in terms of increased target organ damage such as renal outcomes in patients
with normal kidney function and cardiovascular events. So the Masked hypertension is risk
in patients with CKD is lees well defined.
This study to evaluate the association between masked hypertension and kidney function and
markers cardiovascular target organ damage, this study used the cross-sectional study that
performed 24-hour ambulatory blood pressures in 1492 men and woman who has diagnosed
with CKD enrolled in the Chronic Renal Insufficiency Cohort Study. The participant divided
by categorized into controlled BP, white-coat masked, and sustained hypertension on the
basis of clinic and 24-hour ambulatory. And they obtained echocardiograms and measured
pulse wave velocity in 1278 and 1394 participants.

The result of this study that the mean age of the study population was 63.1 years, 55.8% were
male, and 38.9% were non-Hispanic black. The percentages of participantswith controlled
BP,white-coat, masked, and sustained hypertensionwere 49.3%, 4.1%, 27.8%, and 18.8%,
respectively. Compared with controlled BP, masked hypertension independently associated
with low eGFR (-3.2 ml/min per 1.73 m2; 95% confidence interval, -5.5 to -0.9), higher
proteinuria( +0.9 unit higher in log2 urine protein; 95% confidence interval, 0.7 to 1.1), and
higher left ventricularmass index (+2.52 g/m2.7; 95% confidence interval, 0.9 to 4.1), and
pulse wave velocity (+0.92 m/s; 95% confidence interval,0.5 to 1.3). Participants with
masked hypertension had lower eGFR only in the presence of elevated nighttime BP (-3.6
ml/min per 1.73 m2; 95% confidence interval, -6.1 to -1.1; versus -1.4 ml/min per 1.73 m2;
95% confidence interval, 26.9 to 4.0, among those with nighttime BP <120/70 mmHg; P
value for interaction with nighttime systolic BP 0.002).
We concluded that masked hypertension is associated with lower eGFR, proteinuria, and
cardiovascular target organ damage and common in patients with CKD and. In patients with
CKD, ambulatory BP characterizes the relationship between BP and target organ damage
better than BP measured in the clinic alone.
Will be presented by Reysginawati
On Friday, April 22th 2016