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Effect of ambulatory blood pressure monitoring guided antihypertensive treatment on renal progression in patients with chronic kidney disease: a randomized comparative study

 Yunmi Kim  ;  Jayoun Kim  ;  Sung Woo Lee  ;  Suah Sung  ;  Tae-Hyun Yoo  ;  Kyu-Beck Lee  ;  Young-Hwan Hwang  ;  Taehee Kim  ;  Sun Woo Kang  ;  Yeong Hoon Kim  ;  Kook-Hwan Oh 
 JOURNAL OF HYPERTENSION, Vol.39(2) : 325-332, 2021-02 
Journal Title
Issue Date
Antihypertensive Agents / therapeutic use ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Humans ; Hypertension* / complications ; Hypertension* / drug therapy ; Renal Insufficiency, Chronic* / complications ; Renal Insufficiency, Chronic* / drug therapy
Objectives: Adequate blood pressure (BP) control is pivotal for managing chronic kidney disease (CKD). The optimal approach for monitoring BP to delay CKD progression is not yet clear.

Methods: Patients with hypertension and CKD stage 3-4 were randomized into ambulatory blood pressure monitoring (ABPM) or office BP groups. All patients had ABPM at baseline and 18 months, and the ABPM group additionally underwent ABPM at 3 and 6 months. Each ABPM result was notified only for the ABPM group. The BP target was daytime ABP less than 135/85 mmHg for the ABPM group and office BP less than 140/90 mmHg for the office BP group. The primary outcome was decrease in estimated glomerular filtration rate (eGFR) during 18 months.

Results: A total of 146 patients were randomized into the ABPM (n = 69) and office BP groups (n = 77). Although office BP was comparable in the two groups at baseline, daytime ABP was higher in the ABPM group (median 140 vs. 132 mmHg). Initial eGFR was 35.7 ± 12.5 ml/min per 1.73 m2 in the ABPM group and 34.6 ± 12.0 ml/min per 1.73 m2 in the office BP group. eGFR change was -5.5 [95% confidence interval (95% CI) -7.7 to -3.4] ml/min per 1.73 m2 in the ABPM group and -5.0 (95% CI -6.9 to -3.0) ml/min per 1.73 m2 in the office BP group (P = 0.704). Renal events occurred in 10 patients (15.6%) from the ABPM group and five (7.1%) from the office BP group (P = 0.120).

Conclusion: The present study did not show a beneficial effect of ABPM for controlling hypertension in CKD compared with conventional office BP monitoring in terms of renal outcomes.

Trial registration: ClinicalTrials.gov NCT02417571.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
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