title: Differences between office and 24-hour blood pressure control in hypertensive patients with CKD: A 5,693-patient cross-sectional analysis from Spain.
abstract: BACKGROUND
  Previous studies have examined control rates of office blood pressure (BP) in chronic kidney disease (CKD). However, recent evidence suggests major discrepancies between office and 24-hour BP values in hypertensive populations. This study examined concordance/discordance between office- and ambulatory-based BP control in a large cohort of patients with CKD.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  5,693 hypertensive individuals with CKD stages 1-5 from the Spanish ABPM (ambulatory BP monitoring) Registry.
  
  
  METHODS
  Thresholds of 140/90 and 130/80 mm Hg for office BP and 24-hour ambulatory BP, respectively. Age, sex, body mass index, waist circumference, hypertension duration, kidney measures, diabetes, dyslipidemia, target-organ damage, and cardiovascular comorbid conditions.
  
  
  RESULTS
  Misclassification of BP control as "white-coat" hypertension (office BP ≥140/90 mm Hg, 24-hour BP <130/80 mm Hg) or masked hypertension (office BP <140/90 mm Hg, 24-hour BP ≥130/80 mm Hg).
  
  
  METHODS
  Standardized office-based BP and 24-hour ABPM.
  
  
  RESULTS
  Mean age was 61.0 ± 13.9 (SD) years and 52.6% were men. The proportion with white-coat hypertension was 28.8% (36.8% of patients with office BP ≥140/90 mm Hg) and that of masked hypertension was 7.0% (but 32.1% of patients with office BP <140/90 mm Hg). Female sex, aging, obesity, and target-organ damage were associated with white-coat hypertension; aging and obesity were associated with masked hypertension. Only 21.7% and 8.1% of the CKD population had office BP <140/90 and <130/80 mm Hg, respectively. In contrast, 43.5% of individuals had average 24-hour BP <130/80 mm Hg.
  
  
  CONCLUSIONS
  Cross-sectional design, longitudinal associations cannot be established.
  
  
  CONCLUSIONS
  Misclassification of BP control at the office was observed in 1 of 3 hypertensive patients with CKD. Ambulatory-based control rates were far better than office-based rates. Nevertheless, the burden of uncontrolled ambulatory BP and misclassification of BP control at the office constitutes a call for wider use of ABPM to evaluate the success of hypertension treatment in patients with CKD.
authors.affiliation: Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo, Spain. manuel.gorostidi@sespa.princast.es
authors.forename: Manuel
authors.initials: M
authors.lastname: Gorostidi
authors.forename: Pantelis A
authors.initials: PA
authors.lastname: Sarafidis
authors.forename: Alejandro
authors.initials: A
authors.lastname: de la Sierra
authors.forename: Julian
authors.initials: J
authors.lastname: Segura
authors.forename: Juan J
authors.initials: JJ
authors.lastname: de la Cruz
authors.forename: Jose R
authors.initials: JR
authors.lastname: Banegas
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
mesh_terms: D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D013030:Spain
keywords: Chronic kidney disease; ambulatory; control; hypertension; treatment