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Masked hypertension, rather than white-coat hypertension, has a prognostic role in patients with non-dialysis chronic kidney disease.
International Journal of Cardiology 2017 March 2
OBJECTIVE: Masked hypertension (MHT) and white-coat hypertension (WCHT) have been studied among the general population and hypertensive patients. However, little insight is available on the prognosis of MHT and WCHT in patients with chronic kidney disease (CKD). We investigated the role of MHT and WCHT in the prognosis of patients with non-dialysis CKD.
METHODS: A prospective cohort study was conducted between July 2010 and December 2014. A total of 588 patients with non-dialysis CKD were enrolled for ambulatory and clinic blood pressure (BP) monitoring. Patients were divided into four groups according to levels of clinic and ambulatory BP: normotension (NT), WCHT, MHT, and sustained hypertension (SHT). We recorded the time to: total mortality, renal events, and cardiovascular events. Multivariate Cox regression analyses were explored to ascertain the prognostic value of MHT and WCHT for these end points.
RESULTS: Fifty-six CKD patients (9.5%) exhibited WCHT and 121 (20.6%) demonstrated MHT. There were no differences in incidence of total mortality or renal and cardiovascular events between patients with WCHT and those with NT, whereas the occurrence of these three events was higher in patients with MHT and SHT than in patients with NT (P<0.05). Moreover, patients with SHT had the highest incidence of renal and cardiovascular events (P<0.05). Multivariate Cox regression analyses showed that MHT (vs. NT) and SHT (vs. NT) were associated with an increased risk for total mortality (MHT: hazard ratio [HR], 8.88, 95% confidence interval [CI], 1.04-75.59; SHT: 8.15, 1.02-65.24), renal events (MHT: 3.70, 1.23-11.12; SHT: 3.95, 1.42-11.01), major adverse cardiac and cerebrovascular events (MACCE) (MHT: 8.66, 1.09-68.79; SHT: 11.16, 1.48-84.03), whereas WCHT (vs. NT) was not associated with these risks.
CONCLUSIONS: MHT (rather than WCHT) is associated with a risk of total mortality, MACCE, and renal events in patients with non-dialysis CKD.
METHODS: A prospective cohort study was conducted between July 2010 and December 2014. A total of 588 patients with non-dialysis CKD were enrolled for ambulatory and clinic blood pressure (BP) monitoring. Patients were divided into four groups according to levels of clinic and ambulatory BP: normotension (NT), WCHT, MHT, and sustained hypertension (SHT). We recorded the time to: total mortality, renal events, and cardiovascular events. Multivariate Cox regression analyses were explored to ascertain the prognostic value of MHT and WCHT for these end points.
RESULTS: Fifty-six CKD patients (9.5%) exhibited WCHT and 121 (20.6%) demonstrated MHT. There were no differences in incidence of total mortality or renal and cardiovascular events between patients with WCHT and those with NT, whereas the occurrence of these three events was higher in patients with MHT and SHT than in patients with NT (P<0.05). Moreover, patients with SHT had the highest incidence of renal and cardiovascular events (P<0.05). Multivariate Cox regression analyses showed that MHT (vs. NT) and SHT (vs. NT) were associated with an increased risk for total mortality (MHT: hazard ratio [HR], 8.88, 95% confidence interval [CI], 1.04-75.59; SHT: 8.15, 1.02-65.24), renal events (MHT: 3.70, 1.23-11.12; SHT: 3.95, 1.42-11.01), major adverse cardiac and cerebrovascular events (MACCE) (MHT: 8.66, 1.09-68.79; SHT: 11.16, 1.48-84.03), whereas WCHT (vs. NT) was not associated with these risks.
CONCLUSIONS: MHT (rather than WCHT) is associated with a risk of total mortality, MACCE, and renal events in patients with non-dialysis CKD.
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