title: Effects of age on hypertensive status in patients with chronic kidney disease.
abstract: OBJECTIVE
  To evaluate effect of age on hypertensive status in chronic kidney disease (CKD).
  
  
  METHODS
  We studied 459 prevalent CKD patients (stages 2-5, no dialysis), grouped by age (< 55, 55-64, 65-74, >or= 75 years), undergoing clinical blood pressure (CBP) and ambulatory blood pressure (ABP) measurement.
  
  
  RESULTS
  Prevalence of diabetes, left ventricular hypertrophy and previous cardiovascular disease progressively increased with aging; glomerular filtration rate (GFR) and hemoglobin decreased. Achievement of CBP target decreased from 16% in patients < 55 years to 6% in those >or= 75 years (P = 0.023). ABP 24-h systolic rose while diastolic decreased, with a consequent pulse pressure increase from 45 +/- 8 to 65 +/- 14 mmHg (P < 0.0001). Age, proteinuria, diabetes, cardiovascular disease and anemia but not GFR predicted higher 24-h pulse pressure. CBP overestimated systolic/diastolic daytime ABP by 14 +/- 18/7 +/- 11 mmHg on average, a greater difference in older than younger groups (P < 0.005). Conversely, CBP night-time ABP difference did not vary among groups (24 +/- 20/16 +/- 11 mmHg). These age-dependent differences determined a rising prevalence of white-coat hypertension (from 19 to 40%, P = 0.001) and night/day ratio of at least 0.9 (from 43 to 66%, P = 0.0004). Age, diabetes, left ventricular hypertrophy and anemia but not GFR predicted nondipping status. Among the oldest patients, 13% had diastolic CBP below 70 mmHg, with 48% below the corresponding values of daytime (< 69 mmHg) or night-time ABP (< 60 mmHg).
  
  
  CONCLUSIONS
  In CKD, prevalence of white-coat hypertension, nondipping status and potentially dangerous low diastolic ABP increases with aging. This suggests wider use of ABP monitoring in older patients and need for trials addressing identification of an age-specific blood pressure target.
authors.affiliation: Department of Nephrology, Second University of Naples, Italy. roberto.minutolo@unina2.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Minutolo
authors.forename: Silvio
authors.initials: S
authors.lastname: Borrelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.forename: Raffaele
authors.initials: R
authors.lastname: Scigliano
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bellizzi
authors.forename: Bruno
authors.initials: B
authors.lastname: Cianciaruso
authors.forename: Felice
authors.initials: F
authors.lastname: Nappi
authors.forename: Pasquale
authors.initials: P
authors.lastname: Zamboli
authors.forename: Fausta
authors.initials: F
authors.lastname: Catapano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Conte
authors.forename: Luca
authors.initials: L
authors.lastname: De Nicola
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D007674:Kidney Diseases / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies