European Journal of Cardiovascular Medicine

Background: Ambulatory blood pressure (BP) measurement, compared to office blood pressure measurement, provides for better risk stratification in essential hypertension, but its prognostic role in non-dialysis chronic kidney disease has not been well studied. Methods: In 436 consecutive individuals with chronic kidney disease, the prognostic value of daytime and nighttime systolic blood pressure (SBP) and diastolic blood pressure (DBP) in contrast with office measurements was assessed. Time to renal mortality (end-stage renal disease or death) and time to fatal and nonfatal cardiovascular events were the primary end points. Patients were categorised using BP quintiles. Results: The patients had a mean (SD) age of 65.1 (13.6) years and a glomerular filtration rate of 42.9 (19.7) mL/min/1.73 m2. Of the participants, 41.7% were female, 36.5% had diabetes, and 30.5% had cardiovascular disease. SBP/DBP values measured in the office were 146 (19)/82(12)mmHg; midday values were 131(17)/75 (11)mmHg, and nighttime values were 122(20)/66 (10)mmHg. 155 and 103 patients, respectively, achieved the renal and cardiovascular end points during follow-up (median, 4.2 years).Patients with an SBP of 136 to 146 mmHg and those with an SBP greater than 146 mmHg had an increased adjusted risk of cardiovascular endpoint (hazard ratio [HR], 2.23; 95% confidence interval [CI], 1.13-4.41and3.07;1.54-6.09) and renal death compared with those with a daytime SBP of 126 to 135 mmHg (1.72;1.022.89and1.85;1.11-3.08). In comparison to the reference SBP value of 106-114 mmHg, night time SBPs of 125 to 137 mmHg and higher than 137 mmHg also raised the risk of the cardiovascular endpoint (HR, 2.52;95%CI, 1.11-5.71and4.00;1.77-9.02) and renal endpoint (1.87; 1.03-3.43and2.54;1.41-4.57). The risk of the kidney or cardiovascular endpoints was not predicted by office blood pressure monitoring. Patients who didn't dip or did it backwards were more likely to experience both outcomes. Conclusion: When dealing with chronic kidney disease, ambulatory blood pressure monitoring, particularly at night, provides for a more precise prognosis of renal and cardiovascular risk however office blood pressure monitoring makes no prognoses.