Home and ambulatory blood pressure monitoring in chronic kidney disease.
OBJECTIVE
Whereas blood pressures (BPs) obtained in the clinic have formed the basis of diagnosis and treatment of hypertension among patients with chronic kidney disease (CKD), home and ambulatory BP monitoring obtained outside the physician's office have emerged as viable alternatives for the surveillance of hypertension. The purpose of this review is to discuss the recent advances in out-of-office BP recordings in the management of patients with CKD including those on hemodialysis.


RESULTS
In patients with CKD not yet on dialysis, hypertension is often seemingly difficult to control in part because of 'white-coat hypertension'. Masked hypertension is seen in about 8% of patients. Nondipping ambulatory BP manifests early in the course of CKD but may not be independently associated with end-stage renal disease. Out-of-office measured BPs better predict end-organ damage and mortality outcomes in CKD and hemodialysis patients. The analysis of patterns of ambulatory BP monitoring has revealed that elevated BP in these patients is associated with increased arterial stiffness and a blunted rate of rise in BP between dialysis with volume overload.


CONCLUSIONS
It is recommended that the diagnosis and treatment of hypertension among patients with CKD is best done with home (or ambulatory) BP monitoring.
Agarwal
Rajiv
R
Indiana University School of Medicine and Richard L. Roudebush VA Medical Center, Indianapolis, Indiana 46202, USA. ragarwal@iupui.edu
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002908:Chronic Disease; D006699:Home Care Services; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D015203:Reproducibility of Results
D000959:Antihypertensive Agents