title: Blood pressure recordings within and outside the clinic and cardiovascular events in chronic kidney disease.
abstract: BACKGROUND
  Blood pressure (BP) measured outside the clinic correlates better with cardiovascular outcomes in patients with essential hypertension. To assess the role of out-of-clinic BP recordings in predicting cardiovascular events in patients with chronic kidney disease (CKD), a prospective cohort study was conducted in 217 veterans with CKD.
  
  
  METHODS
  BP was measured outside the clinic at home and by 24-hour ambulatory recordings, and in the clinic by 'routine' and standardized methods. Patients were followed over a median of 3.4 years to assess the combined end-point of total mortality, myocardial infarction or stroke.
  
  
  RESULTS
  Average (+/-SD) home BP was 147.0 +/- 21.4/78.3 +/- 11.6 mm Hg, 24-hour ambulatory BP 133.5 +/- 16.6/73.1 +/- 11.1 mm Hg and in-clinic BPs were 155.2 +/- 25.6/84.7 +/- 14.2 mm Hg by the standardized method, and 144.5 +/- 24.2/75.4 +/- 14.7 mm Hg by the 'routine' method. A 1 SD increase in systolic BP increased the hazard ratio (HR) of the composite end-point by 1.16 (95% CI 0.89-1.50) for routine BP, 1.57 (95% CI 1.19-2.09) for standardized BP, 1.66 (95% CI 1.27-2.17) for home BP, and 1.42 (95% CI 1.10-1.84) for 24-hour ambulatory BP recording. The HR of the composite end-point was only significant for hypertension defined by 24-hour ambulatory BP monitoring (HR 2.22 (95% CI 1.23-4.01)). Adjusted for the propensity scores, BP measured by the ambulatory technique was not an independent predictor of cardiovascular events. Non-dipping was associated with increased cardiovascular risk, but not when adjusted for other risk factors.
  
  
  CONCLUSIONS
  Risk factors that differentiate hypertension or non-dipping appear to confer a cardiovascular risk in CKD.
authors.affiliation: Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN 46202, USA. ragarwal@iupui.edu
authors.forename: Rajiv
authors.initials: R
authors.lastname: Agarwal
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Andersen
mesh_terms: D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology*; D007674:Kidney Diseases / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology