title: Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease.
abstract: Ambulatory blood pressure (ABP) monitoring provides unique information about day-night patterns of blood pressure (BP). The objectives of this article were to describe ABP patterns in African Americans with hypertensive kidney disease, to examine the joint distribution of clinic BP and ABP, and to determine associations of hypertensive target organ damage with clinic BP and ABP. This study is a cross-sectional analysis of baseline data from the African American Study of Kidney Disease Cohort Study. Masked hypertension was defined by elevated daytime (>or= 135/85 mm Hg) or elevated nighttime (>or= 120/70 mm Hg) ABP in those with controlled clinic BP (<140/90 mm Hg); nondipping was defined by a <or= 10% decrease in mean nighttime systolic BP; reverse dipping was defined by a higher nighttime than daytime systolic BP. Of the 617 participants (mean age: 60.2 years; 62% male; mean estimated glomerular filtration rate: 43.8 mL/min per 1.73 m(2)) with both clinic BP and ABP, 498 participants (80%) had a nondipping or reverse dipping profile. Of the 377 participants with controlled clinic BP (61%), 70% had masked hypertension. Compared with those with controlled clinic BP or white-coat hypertension, target organ damage (proteinuria and left ventricular hypertrophy) was more common in those with elevated nighttime BP, masked hypertension, or sustained hypertension. In conclusion, clinic BP provides an incomplete and potentially misleading assessment of the severity of hypertension in African Americans with hypertensive kidney disease, in large part because of increased nighttime BP. Whether lowering nighttime BP improves clinical outcomes is unknown but should be tested given the substantial burden of BP-related morbidity in this population.
authors.affiliation: Division of Nephrology, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY 10037, USA. vap1@columbia.edu
authors.forename: Velvie
authors.initials: V
authors.lastname: Pogue
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.forename: Michael
authors.initials: M
authors.lastname: Lipkowitz
authors.forename: Robert
authors.initials: R
authors.lastname: Toto
authors.forename: Edgar
authors.initials: E
authors.lastname: Miller
authors.forename: Marquetta
authors.initials: M
authors.lastname: Faulkner
authors.forename: Stephen
authors.initials: S
authors.lastname: Rostand
authors.forename: Leena
authors.initials: L
authors.lastname: Hiremath
authors.forename: Mohammed
authors.initials: M
authors.lastname: Sika
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kendrick
authors.forename: Bo
authors.initials: B
authors.lastname: Hu
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Lawrence
authors.initials: L
authors.lastname: Appel
authors.forename: Robert A
authors.initials: RA
authors.lastname: Phillips
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000208:ethnology; D000368:Aged; D000554:Ambulatory Care Facilities; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000208:ethnology / Q000503:physiopathology*; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000208:ethnology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D055815:Young Adult