title: Masked Hypertension and Elevated Nighttime Blood Pressure in CKD: Prevalence and Association with Target Organ Damage.
abstract: OBJECTIVE
  Masked hypertension and elevated nighttime BP are associated with increased risk of hypertensive target organ damage and adverse cardiovascular and renal outcomes in patients with normal kidney function. The significance of masked hypertension for these risks in patients with CKD is less well defined. The objective of this study was to evaluate the association between masked hypertension and kidney function and markers of cardiovascular target organ damage, and to determine whether this relationship was consistent among those with and without elevated nighttime BP.
  
  
  METHODS
  This was a cross-sectional study. We performed 24-hour ambulatory BP in 1492 men and women with CKD enrolled in the Chronic Renal Insufficiency Cohort Study. We categorized participants into controlled BP, white-coat, masked, and sustained hypertension on the basis of clinic and 24-hour ambulatory BP. We obtained echocardiograms and measured pulse wave velocity in 1278 and 1394 participants, respectively.
  
  
  RESULTS
  The percentages of participants with controlled BP, white-coat, masked, and sustained hypertension were 49.3%, 4.1%, 27.8%, and 18.8%, respectively. Compared with controlled BP, masked hypertension independently associated with low eGFR (-3.2 ml/min per 1.73 m(2); 95% confidence interval, -5.5 to -0.9), higher proteinuria (+0.9 unit higher in log2 urine protein; 95% confidence interval, 0.7 to 1.1), and higher left ventricular mass index (+2.52 g/m(2.7); 95% confidence interval, 0.9 to 4.1), and pulse wave velocity (+0.92 m/s; 95% confidence interval, 0.5 to 1.3). Participants with masked hypertension had lower eGFR only in the presence of elevated nighttime BP (-3.6 ml/min per 1.73 m(2); 95% confidence interval, -6.1 to -1.1; versus -1.4 ml/min per 1.73 m(2); 95% confidence interval, -6.9 to 4.0, among those with nighttime BP <120/70 mmHg; P value for interaction with nighttime systolic BP 0.002).
  
  
  CONCLUSIONS
  Masked hypertension is common in patients with CKD and associated with lower eGFR, proteinuria, and cardiovascular target organ damage. In patients with CKD, ambulatory BP characterizes the relationship between BP and target organ damage better than BP measured in the clinic alone.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Drawz
authors.forename: Arnold B
authors.initials: AB
authors.lastname: Alper
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Anderson
authors.forename: Carolyn S
authors.initials: CS
authors.lastname: Brecklin
authors.forename: Jeanne
authors.initials: J
authors.lastname: Charleston
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fischer
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Hsu
authors.forename: Yonghong
authors.initials: Y
authors.lastname: Huan
authors.forename: Martin G
authors.initials: MG
authors.lastname: Keane
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Gail K
authors.initials: GK
authors.lastname: Makos
authors.forename: Edgar R
authors.initials: ER
authors.lastname: Miller
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.forename: Susan P
authors.initials: SP
authors.lastname: Steigerwalt
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Taliercio
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
authors.forename: Jackson T
authors.initials: JT
authors.lastname: Wright
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology; D008297:Male; D059468:Masked Hypertension / Q000150:complications* / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology*
keywords: ambulatory blood pressure monitoring; blood pressure; cardiovascular disease; chronic kidney disease; humans; hypertension; left ventricular hypertrophy; masked hypertension; nighttime; pulse wave analysis