title: Masked Uncontrolled Hypertension in CKD.
abstract: Masked uncontrolled hypertension (MUCH) is diagnosed in patients treated for hypertension who are normotensive in the clinic but hypertensive outside. In this study of 333 veterans with CKD, we prospectively evaluated the prevalence of MUCH as determined by ambulatory BP monitoring using three definitions of hypertension (daytime hypertension ≥135/85 mmHg; either nighttime hypertension ≥120/70 mmHg or daytime hypertension; and 24-hour hypertension ≥130/80 mmHg) or by home BP monitoring (hypertension ≥135/85 mmHg). The prevalence of MUCH was 26.7% by daytime ambulatory BP, 32.8% by 24-hour ambulatory BP, 56.1% by daytime or night-time ambulatory BP, and 50.8% by home BP. To assess the reproducibility of the diagnosis, we repeated these measurements after 4 weeks. Agreement in MUCH diagnosis by ambulatory BP was 75-78% (κ coefficient for agreement, 0.44-0.51), depending on the definition used. In contrast, home BP showed an agreement of only 63% and a κ coefficient of 0.25. Prevalence of MUCH increased with increasing clinic systolic BP: 2% in the 90-110 mmHg group, 17% in the 110-119 mmHg group, 34% in the 120-129 mmHg group, and 66% in the 130-139 mmHg group. Clinic BP was a good determinant of MUCH (receiver operating characteristic area under the curve 0.82; 95% confidence interval 0.76-0.87). In diagnosing MUCH, home BP was not different from clinic BP. In conclusion, among people with CKD, MUCH is common and reproducible, and should be suspected when clinic BP is in the prehypertensive range. Confirmation of MUCH diagnosis should rely on ambulatory BP monitoring.
authors.affiliation: Indiana University School of Medicine; Richard L. Roudebush Veterans Affairs Administration Medical Center, Indianapolis, Indiana ragarwal@iu.edu.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Agarwal
authors.affiliation: Indiana University School of Medicine; Richard L. Roudebush Veterans Affairs Administration Medical Center, Indianapolis, Indiana.
authors.forename: Maria K
authors.initials: MK
authors.lastname: Pappas
authors.affiliation: Indiana University School of Medicine; Richard L. Roudebush Veterans Affairs Administration Medical Center, Indianapolis, Indiana.
authors.forename: Arjun D
authors.initials: AD
authors.lastname: Sinha
mesh_terms: D000368:Aged; D019540:Area Under Curve; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D059468:Masked Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D015203:Reproducibility of Results; D012648:Self Care; D013997:Time Factors
keywords: blood pressure; chronic kidney disease; hypertension