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

被引:64
作者
Agarwal, Rajiv [1 ,2 ]
Peixoto, Aldo J. [3 ,4 ]
Santos, Sergio F. F. [5 ]
Zoccali, Carmine [6 ,7 ]
机构
[1] Indiana Univ, Div Nephrol, Dept Med, Indianapolis, IN 46202 USA
[2] Richard L Roudebush VA Med Ctr, Indianapolis, IN 46202 USA
[3] Yale Univ, Sch Med, New Haven, CT USA
[4] CT & VA Connecticut Healthcare Syst, West Haven, CT USA
[5] Univ Estado Rio De Janeiro, Rio De Janeiro, Brazil
[6] Osped Riuniti, Calabria, Italy
[7] Osped Riuniti, CNR IBIM Epidemiol Clin & Fisiopatol Malattie Ren, Calabria, Italy
关键词
ambulatory blood pressure monitoring; cardiovascular disease; chronic kidney disease; home blood pressure monitoring; hypertension; LEFT-VENTRICULAR HYPERTROPHY; CHRONIC-HEMODIALYSIS PATIENTS; WHITE COAT HYPERTENSION; STAGE RENAL-DISEASE; HEART-RATE RESPONSE; PERITONEAL-DIALYSIS; PROGNOSTIC VALUE; CARDIOVASCULAR MORTALITY; NOCTURNAL DECLINE; PHYSICAL-ACTIVITY;
D O I
10.1097/MBP.0b013e3283262f58
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
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 BR 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 BR 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. Blood Press Monit 14:2-11 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
引用
收藏
页码:2 / 11
页数:10
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