title: Assessment of achieved clinic and ambulatory blood pressure recordings and outcomes during treatment in hypertensive patients with CKD: a multicenter prospective cohort study.
abstract: BACKGROUND
  We investigated the effect of having clinic and/or ambulatory blood pressures (BPs) not at goal on cardiorenal risk in patients with non-dialysis-dependent chronic kidney disease (CKD).
  
  
  METHODS
  Multicenter prospective study.
  
  
  METHODS
  489 consecutive hypertensive patients with CKD (stages 1-5) with concomitant assessment of ambulatory and clinic BPs followed up in tertiary nephrology clinics.
  
  
  METHODS
  Achievement of goal for ambulatory (day- and night-time BPs <135/85 and <120/70mmHg, respectively) and clinic (<140/90mmHg) BPs was used to create 4 BP groups: clinic and ambulatory BPs at goal (group 1), clinic BP above goal and ambulatory BP at goal (group 2), clinic BP at goal and ambulatory BP above goal (group 3), and clinic and ambulatory BPs above goal (group 4).
  
  
  RESULTS
  Composite cardiovascular event outcome (fatal and nonfatal myocardial infarction, congestive heart failure, stroke, revascularization, peripheral vascular disease, and nontraumatic amputation) and a composite renal outcome (maintenance dialysis therapy or death).
  
  
  METHODS
  Clinic and 24-hour ambulatory BPs.
  
  
  RESULTS
  Mean age was 64.4±14.2 (SD) years; 41% were women, and diabetes and previous cardiovascular disease were present in 36% and 30%, respectively. Groups 1-4 contained 16.8%, 22.1%, 14.5%, and 46.6%, respectively, of the overall number of participants. Median follow-up was 5.2 years. Compared to group 1, the adjusted risk of the composite cardiovascular outcome was higher in groups 3 (HR, 3.17; 95%CI, 1.50-6.69) and 4 (HR, 2.83; 95%CI, 1.50-5.34), but not in group 2 (HR, 1.55; 95%CI, 0.75-3.19). Similarly, the risk of the composite renal outcome was higher in groups 3 (HR, 3.59; 95%CI, 2.05-6.27) and 4 (HR, 2.96; 95%CI, 1.83-4.78), but not group 2 (HR, 1.24; 95%CI, 0.67-2.27). Sensitivity analyses confirmed that these results were independent from the thresholds used for defining groups.
  
  
  CONCLUSIONS
  Only white patients were enrolled. Observational design does not allow for causality to be established.
  
  
  CONCLUSIONS
  In patients with treated CKD, clinic BP above goal and ambulatory BP at goal identify a low-risk condition, whereas clinic BP at goal and ambulatory BP above goal are associated with higher cardiorenal risk, similar to that observed in patients with both clinic and ambulatory BPs above goal.
authors.affiliation: Division of Nephrology, Second University of Naples, Naples, Italy. Electronic address: roberto.minutolo@unina2.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Minutolo
authors.affiliation: Department of Medicine, VA San Diego Healthcare System and University of California at San Diego Medical School, San Diego, CA.
authors.forename: Francis B
authors.initials: FB
authors.lastname: Gabbai
authors.affiliation: Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush VA Medical Center, Indianapolis, IN.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Agarwal
authors.affiliation: Department of Medicine and Public Health, Second University of Naples, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.affiliation: Division of Nephrology, Second University of Naples, Naples, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Borrelli
authors.affiliation: Nephrology Division, University Hospital, Salerno, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bellizzi
authors.affiliation: Nephrology Division, County Hospital, Nola, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Nappi
authors.affiliation: Division of Nephrology, Second University of Naples, Naples, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Stanzione
authors.affiliation: Division of Nephrology, Second University of Naples, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Conte
authors.affiliation: Division of Nephrology, Second University of Naples, Naples, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: De Nicola
mesh_terms: D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory / Q000592:standards*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Chronic kidney disease (CKD); ambulatory blood pressure (BP); blood pressure control; blood pressure goal; cardiorenal risk; clinic blood pressure; masked hypertension; white coat hypertension