Ambulatory Blood Pressure Monitoring: Profiles in Chronic Kidney Disease Patients and Utility in Management

      Optimal control of blood pressure (BP) may reduce the risk of progression of CKD. Misclassification of hypertension (HTN) and status of control may result in suboptimal management. Clinic or home BP may overestimate or underestimate status of control compared with ambulatory BP monitoring (ABPM), which is considered the gold standard. The latter relates not only to the superiority of ABPM concerning outcome prognosis but also to its ability to accurately diagnose white coat and masked HTN, which is critical in assuring adequate BP control. However, ABPM has not gained widespread use in practice because of limited third-party reimbursement and a paucity of high quality randomized controlled intervention studies evaluating its use. Herein, we review HTN phenotypes that have been identified in patients with CKD, and the potential value of ABPM in this high-risk population.

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        • Sarnak M.J.
        • Greene T.
        • Wang X.
        • et al.
        The effect of a lower target blood pressure on the progression of kidney disease: long-term follow-up of the modification of diet in renal disease study.
        Ann Intern Med. 2005; 142: 342-351
        • Astor B.C.
        • Matsushita K.
        • Gansevoort R.T.
        • et al.
        Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts.
        Kidney Int. 2011; 79: 1331-1340
        • Lv J.
        • Neal B.
        • Ehteshami P.
        • et al.
        Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: a systematic review and meta-analysis.
        PLoS Med. 2012; 9: e1001293
        • Wright Jr., J.T.
        • Williamson J.D.
        • Whelton P.K.
        • et al.
        • Sprint Research Group
        A randomized trial of intensive versus standard blood-pressure control.
        N Engl J Med. 2015; 373: 2103-2116
        • Velasquez M.T.
        • Beddhu S.
        • Nobakht E.
        • Rahman M.
        • Raj D.S.
        Ambulatory blood pressure in chronic kidney disease: ready for prime time?.
        Kidney Int Rep. 2016; 1: 94-104
        • Pickering T.G.
        • Shimbo D.
        • Haas D.
        Ambulatory blood-pressure monitoring.
        N Engl J Med. 2006; 354: 2368-2374
        • Gabbai F.B.
        • Rahman M.
        • Hu B.
        • et al.
        Relationship between ambulatory BP and clinical outcomes in patients with hypertensive CKD.
        Clin J Am Soc Nephrol. 2012; 7: 1770-1776
        • Drawz P.E.
        • Alper A.B.
        • Anderson A.H.
        • et al.
        Masked hypertension and elevated nighttime blood pressure in CKD: prevalence and association with target organ damage.
        Clin J Am Soc Nephrol. 2016; 11: 642-652
        • Piper M.A.
        • Evans C.V.
        • Burda B.U.
        • Margolis K.L.
        • O'Connor E.
        • Whitlock E.P.
        Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force.
        Ann Intern Med. 2015; 162: 192-204
        • Appel L.J.
        • Wright Jr., J.T.
        • Greene T.
        • et al.
        Intensive blood-pressure control in hypertensive chronic kidney disease.
        N Engl J Med. 2010; 363: 918-929
        • Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group
        KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Chapter 1: introduction.
        Kidney Int Suppl (2011). 2012; 2: 343-346
        • Siu A.L.
        • U.S.P.S.T. Force
        Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2015; 163: 778-786
        • Muntner P.
        • Anderson A.
        • Charleston J.
        • et al.
        Hypertension awareness, treatment, and control in adults with CKD: results from the chronic renal insufficiency cohort (CRIC) study.
        Am J Kidney Dis. 2010; 55: 441-451
        • Centers for Disease Control and Prevention
        Chronic Kidney Disease Surveillance System—United States. [cited 2018 July 25, 2018].
        (Available at:)
        • Chobanian A.V.
        • Bakris G.L.
        • Black H.R.
        • et al.
        The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report.
        JAMA. 2003; 289: 2560-2572
        • Whelton P.K.
        • Carey R.M.
        • Aronow W.S.
        • et al.
        2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines.
        J Am Coll Cardiol. 2018; 71: e127-e248
        • Muntner P.
        • Carey R.M.
        • Gidding S.
        • et al.
        Potential US population impact of the 2017 ACC/AHA high blood pressure guideline.
        Circulation. 2018; 137: 109-118
        • Coresh J.
        • Selvin E.
        • Stevens L.A.
        • et al.
        Prevalence of chronic kidney disease in the United States.
        JAMA. 2007; 298: 2038-2047
        • Murphy D.
        • McCulloch C.E.
        • Lin F.
        • et al.
        Trends in prevalence of chronic kidney disease in the United States.
        Ann Intern Med. 2016; 165: 473-481
        • Zhang L.
        • Wang F.
        • Wang L.
        • et al.
        Prevalence of chronic kidney disease in China: a cross-sectional survey.
        Lancet. 2012; 379: 815-822
        • Cohen D.L.
        • Huan Y.
        • Townsend R.R.
        Ambulatory blood pressure in chronic kidney disease.
        Curr Hypertens Rep. 2013; 15: 160-166
        • Rao M.V.
        • Qiu Y.
        • Wang C.
        • Bakris G.
        Hypertension and CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES), 1999-2004.
        Am J Kidney Dis. 2008; 51: S30-S37
        • Agarwal R.
        Implications of blood pressure measurement technique for implementation of systolic blood pressure intervention trial (SPRINT).
        J Am Heart Assoc. 2017; 6: 03
        • Thomas G.
        • Drawz P.E.
        BP measurement techniques: what they mean for patients with kidney disease.
        Clin J Am Soc Nephrol. 2018; 13: 1124-1131
        • Johansson J.K.
        • Puukka P.J.
        • Jula A.M.
        Oscillometric and auscultatory blood pressure measurement in the assessment of blood pressure and target organ damage.
        Blood Press Monit. 2014; 19: 6-13
        • Alpert B.S.
        • Quinn D.
        • Gallick D.
        Oscillometric blood pressure: a review for clinicians.
        J Am Soc Hypertens. 2014; 8: 930-938
        • Viera A.J.
        • Shimbo D.
        Ambulatory blood pressure phenotypes and the risk for hypertension.
        Curr Hypertens Rep. 2014; 16: 481
        • Myers M.G.
        • Godwin M.
        • Dawes M.
        • Kiss A.
        • Tobe S.W.
        • Kaczorowski J.
        Measurement of blood pressure in the office: recognizing the problem and proposing the solution.
        Hypertension. 2010; 55: 195-200
        • Williams B.
        • Manica G.
        • Spiering W.
        2018 ESC/ESH guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension.
        J Hypertens. 2018; 36: 1953-2041
        • Agarwal R.
        • Pappas M.K.
        • Sinha A.D.
        Masked uncontrolled hypertension in CKD.
        J Am Soc Nephrol. 2016; 27: 924-932
        • Ruiz-Hurtado G.
        • Gorostidi M.
        • Waeber B.
        • Ruilope L.M.
        Ambulatory and home blood pressure monitoring in people with chronic kidney disease. Time to abandon clinic blood pressure measurements?.
        Curr Opin Nephrol Hypertens. 2015; 24: 488-491
        • Drawz P.E.
        • Pajewski N.M.
        • Bates J.T.
        • et al.
        Effect of intensive versus standard clinic-based hypertension management on ambulatory blood pressure: results from the SPRINT (systolic blood pressure intervention trial) ambulatory blood pressure study.
        Hypertension. 2017; 69: 42-50
        • Bundy J.D.
        • Mills K.T.
        • Chen J.
        • Li C.
        • Greenland P.
        • He J.
        Estimating the association of the 2017 and 2014 hypertension guidelines with cardiovascular events and deaths in US adults: an analysis of national data.
        JAMA Cardiol. 2018; 3: 572-581
        • Minutolo R.
        • Agarwal R.
        • Borrelli S.
        • et al.
        Prognostic role of ambulatory blood pressure measurement in patients with nondialysis chronic kidney disease.
        Arch Intern Med. 2011; 171: 1090-1098
        • Bangash F.
        • Agarwal R.
        Masked hypertension and white-coat hypertension in chronic kidney disease: a meta-analysis.
        Clin J Am Soc Nephrol. 2009; 4: 656-664
        • Pluta A.
        • Strozecki P.
        • Manitius J.
        Circadian blood pressure profile in patients with chronic kidney disease stage 1-3.
        Arterial Hypertens. 2015; 19: 187-193
        • Minutolo R.
        • Borrelli S.
        • Scigliano R.
        • et al.
        Prevalence and clinical correlates of white coat hypertension in chronic kidney disease.
        Nephrol Dial Transplant. 2007; 22: 2217-2223
        • Katafuchi E.
        • Nakayama M.
        • Tanaka S.
        • et al.
        Comparison of prognostic values of daytime and night-time systolic blood pressures on renal outcomes in patients with chronic kidney disease.
        Circ J. 2017; 81: 1454-1462
        • Verberk W.J.
        • Kessels A.G.
        • de Leeuw P.W.
        Prevalence, causes, and consequences of masked hypertension: a meta-analysis.
        Am J Hypertens. 2008; 21: 969-975
        • Fernandez Fresnedo G.
        • Franco E.A.
        • Gomez H.E.
        • et al.
        Ambulatory blood pressure monitoring in kidney transplant patients: RETENAL study.
        Transpl Proc. 2012; 44: 2601-2602
        • Mallamaci F.
        • D'Arrigo G.
        • Tripepi R.
        • et al.
        Office, standardized and 24-h ambulatory blood pressure and renal function loss in renal transplant patients.
        J Hypertens. 2018; 36: 119-125
        • Wadei H.M.
        • Amer H.
        • Taler S.J.
        • et al.
        Diurnal blood pressure changes one year after kidney transplantation: relationship to allograft function, histology, and resistive index.
        J Am Soc Nephrol. 2007; 18: 1607-1615
        • Ahmed J.
        • Ozorio V.
        • Farrant M.
        • Van Der Merwe W.
        Ambulatory vs office blood pressure monitoring in renal transplant recipients.
        J Clin Hypertens (Greenwich). 2015; 17: 46-50
        • Drawz P.E.
        • Brown R.
        • De Nicola L.
        • et al.
        Variations in 24-hour BP profiles in cohorts of patients with kidney disease around the world: the I-DARE study.
        Clin J Am Soc Nephrol. 2018; 13: 1348-1357
        • Opelz G.
        • Wujciak T.
        • Ritz E.
        Association of chronic kidney graft failure with recipient blood pressure. Collaborative Transplant Study.
        Kidney Int. 1998; 53: 217-222
        • Wadei H.M.
        • Amer H.
        • Griffin M.D.
        • Taler S.J.
        • Stegall M.S.
        • Textor S.C.
        Abnormal circadian blood pressure pattern 1-year after kidney transplantation is associated with subsequent lower glomerular filtration rate in recipients without rejection.
        J Am Soc Hypertens. 2011; 5: 39-47