MO056HOME BLOOD PRESSURE MEASUREMENT AS SYSTEMATIC TOOL FOR CLINICAL PRACTICE IN CKD PATIENTS

Abstract

Introduction and Aims: The prevalence of arterial hypertension is very high in CKD patients and it increases with lowering GFR. Hypertension represents a modifiable risk factor, which increases proteinuria and the rate of progression of renal and cardiovascular damage. Hence, blood pressure (BP) control is a major task in the treatment of CKD patients. Office blood pressure measurement (OBPM) is less correlated with hypertensive target-organ damage, including albumin excretion rate and renal outcomes, than ambulatory BP measurement (ABPM) or home BP monitoring (HBPM). In addition, in CKD population, it has been reported a prevalence of masked hypertension (MHT) up to 25% and of white coat hypertension (WCH) of 29%. ABPM is the most accurate method, but it has limited availability; this prevents a widespread application in the daily clinical practice. Instead, HBPM is widely available and at low cost, but its clinical use is still far from optimal. The aim of this study is to evaluate the data from the implementation of HBPM in our CKD clinical setting. Methods: We analyzed 560 consecutive stage 3-5 CKD patients (359 m, 201 f, aged 70 ±13 yrs), on tertiary care, who performed HBPM by different schedules. In all of them we evaluated routine OBPM, during a single visit, body weight, eGFR, and the history of diabetes and cardiovascular disease (heart failure, coronary artery disease, stroke or peripheral artery disease). Sustained hypertension (SHT) was defined by OBPM values >140/90 mmHg and HBPM >135/85 mmHg, WCH by OBPM values >140/90 mmHg and HBPM <135/85 mmHg, MHT by OBPM values <140/90 mmHg and HBPM >135/ 85 mmHg. Results: As expected, systolic and diastolic HBPM values were lower than OBPM ones. The average absolute difference in systolic BP between OBPM and HBPM was 14±12 mmHg, and it resulted significantly higher in females and during the period from May to September. These differences between OBPM and HBPM were not related to age, body weight, CKD stage, eGFR or to the presence of diabetes. The 42.7% of CKD patients showed controlled BP values (CBP, i.e. normal systolic and diastolic OBPM and HBPM values), whereas 23.7% had SHT; WCH was detected in 19.3% and MHT in 14.3%. In respect to SHT, WCH patients differ for a lower risk of peripheral and cerebrovascular disease (12.9 % vs 27.8%, p=0.005) and for being younger (69.0±11.9 vs 72.6±11.7 yrs, p<0.05), but not for eGFR, body weight, or prevalence of diabetes. No difference between WCH and CBP patients was observed. MHT patients showed a greater risk of heart failure and coronary artery disease (41.2% vs 23.0%, p=0.0013) than CBP patients; the former were older but no difference emerged regarding eGFR or prevalence of diabetes. The history of cumulative cardiovascular disease was lower in WCH patients than in SHT or MHT (32.4 vs 48.1 vs 46.3 %, p<0.05) patients. Conclusions: Our data confirm that HBPM is useful for BP monitoring in the daily clinical management of CKD patients. HBPM is the most easy tool to detect WCH or MHT, which have different cardiovascular risk profiles, and to modulate anti-hypertensive drug titration. Thus, despite OBPM remained of clinical value, systematic implementation of HBPM should be promoted in CKD patient care management.