Out-of-office blood pressure monitoring in chronic kidney disease

Abstract

Blood pressure (BP) control is vital to the management of patients with chronic kidney disease (CKD) yet most treatment decisions use BPs obtained in the clinic. The purpose of this report is to review the importance of self-measured and automatic ambulatory BPs in the management of patients with CKD. Compared with clinic-obtained BPs, self-measured BP more accurately defines hypertension in CKD. Masked hypertension seems to be associated with higher risk of end-stage renal disease in CKD patients. Conversely, white-coat hypertension seems to be associated with better renal outcomes than those who have persistent hypertension. Ambulatory BP monitoring is the only tool to monitor BP during sleep, diagnose nondipping, and, as self-measured BPs, have greater prognostic power in CKD compared with clinic BP. In hemodialysis patients, self-measured BP, but not pre/post-dialysis BP, shares the combination of high sensitivity and high specificity of greater than 80% to make a diagnosis of hypertension with the reference standard of ambulatory BP monitoring. In addition, self-measured and ambulatory BPs seem to be better correlates of left-ventricular hypertrophy and mortality in hemodialysis patients compared with pre/post-dialysis BP. Emerging data suggest that out-of-office BP monitoring is superior to BP obtained in the clinic when predicting target-organ damage and prognosis. Out-of-office BP monitoring is recommended for the management of hypertension in all stages of CKD.