title: Masked uncontrolled hypertension in patients on maintenance hemodialysis.
abstract: Masked uncontrolled hypertension (MUCH) has been proven to be associated with increased cardiovascular risk in the general population. We performed the current analysis to determine its prevalence in dialysis patients and its association with pulse wave velocity (PWV). From 368 participants of another cohort study, we selected 145 subjects with controlled predialysis blood pressure (BP). All subjects underwent ambulatory BP monitoring and PWV measurement. MUCH was defined as controlled predialysis BP with daytime BP⩾135/85 mm Hg (definition-1); total ambulatory BP⩾130/80 mm Hg (definition-2); and either daytime BP⩾135/85 mm Hg or nighttime BP⩾120/70 mm Hg (definition-3). The prevalence of MUCH was 43.4% (definition-1), 55.9% (definition-2) and 74.5% (definition-3). Multivariable logistic regression analysis showed that the use of antihypertensive medication was the most consistent predictor of MUCH within all 3 definitions (all odds ratio (OR)⩾4.28, P<0.001). Predialysis systolic BP (both OR>1, P⩽0.04), predialysis diastolic BP (both OR>1, P⩽0.001) and hemoglobin (both OR<1, P=0.02) were all significantly associated with MUCH in two models. Interdialytic weight gain (OR=0.52, P=0.02) was associated with MUCH under definition-2, and BMI (OR=0.86, P=0.03) was associated with MUCH under definition-3. Patients with MUCH had significantly elevated PWV compared with their counterparts according to all three definitions with or without adjusting for covariates (all P⩽0.03). In conclusion, MUCH affects a large proportion of dialysis patients with controlled predialysis BP and is associated with increased PWV. Patients on antihypertensive medications and with higher predialysis BP are more likely to have MUCH.
authors.affiliation: Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Wenjin
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Nephrology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Nephrology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China.
authors.forename: Zhuxing
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Department of Blood Purification, The Third Affiliated Hospital of Soochow University, Changzhou, China.
authors.forename: Xiurong
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Hemodialysis, Yijishan Hospital of Wannan Medical College, Wuhu, China.
authors.forename: Jianmei
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Hemodialysis, Yijishan Hospital of Wannan Medical College, Wuhu, China.
authors.forename: Chaoqing
authors.initials: C
authors.lastname: Gao
authors.affiliation: Department of Nephrology, Affiliated Yixing People's Hospital, Jiangsu University, Yixing, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Chu
authors.affiliation: Department of Nephrology, Affiliated Yixing People's Hospital, Jiangsu University, Yixing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Fan
authors.affiliation: Department of Nephrology, Luan People's Hospital, Luan, China.
authors.forename: Youwei
authors.initials: Y
authors.lastname: Bai
authors.affiliation: Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Junwei
authors.initials: J
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology; D008297:Male; D059468:Masked Hypertension / Q000453:epidemiology*; D008875:Middle Aged; D063177:Pulse Wave Analysis