Document Detail


Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease.
MedLine Citation:
PMID:  19047584     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Ambulatory blood pressure (ABP) monitoring provides unique information about day-night patterns of blood pressure (BP). The objectives of this article were to describe ABP patterns in African Americans with hypertensive kidney disease, to examine the joint distribution of clinic BP and ABP, and to determine associations of hypertensive target organ damage with clinic BP and ABP. This study is a cross-sectional analysis of baseline data from the African American Study of Kidney Disease Cohort Study. Masked hypertension was defined by elevated daytime (>or= 135/85 mm Hg) or elevated nighttime (>or= 120/70 mm Hg) ABP in those with controlled clinic BP (<140/90 mm Hg); nondipping was defined by a <or= 10% decrease in mean nighttime systolic BP; reverse dipping was defined by a higher nighttime than daytime systolic BP. Of the 617 participants (mean age: 60.2 years; 62% male; mean estimated glomerular filtration rate: 43.8 mL/min per 1.73 m(2)) with both clinic BP and ABP, 498 participants (80%) had a nondipping or reverse dipping profile. Of the 377 participants with controlled clinic BP (61%), 70% had masked hypertension. Compared with those with controlled clinic BP or white-coat hypertension, target organ damage (proteinuria and left ventricular hypertrophy) was more common in those with elevated nighttime BP, masked hypertension, or sustained hypertension. In conclusion, clinic BP provides an incomplete and potentially misleading assessment of the severity of hypertension in African Americans with hypertensive kidney disease, in large part because of increased nighttime BP. Whether lowering nighttime BP improves clinical outcomes is unknown but should be tested given the substantial burden of BP-related morbidity in this population.
Authors:
Velvie Pogue; Mahboob Rahman; Michael Lipkowitz; Robert Toto; Edgar Miller; Marquetta Faulkner; Stephen Rostand; Leena Hiremath; Mohammed Sika; Cynthia Kendrick; Bo Hu; Tom Greene; Lawrence Appel; Robert A Phillips;
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2008-12-01
Journal Detail:
Title:  Hypertension     Volume:  53     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-18     Completed Date:  2009-01-08     Revised Date:  2013-02-08    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  20-7     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY 10037, USA. vap1@columbia.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
African Americans / ethnology
Aged
Ambulatory Care Facilities*
Blood Pressure / physiology*
Blood Pressure Monitoring, Ambulatory*
Circadian Rhythm / physiology*
Cohort Studies
Cross-Sectional Studies
Female
Humans
Hypertension, Renal / ethnology,  physiopathology*
Kidney / physiopathology
Kidney Diseases / ethnology,  physiopathology*
Male
Middle Aged
Prevalence
Reproducibility of Results
Severity of Illness Index
Young Adult
Grant Support
ID/Acronym/Agency:
2P20 RR11104/RR/NCRR NIH HHS; 5M01 RR-00071/RR/NCRR NIH HHS; M01 00032//PHS HHS; M01 RR00827/RR/NCRR NIH HHS; P20-RR11145/RR/NCRR NIH HHS; UL1 RR024989/RR/NCRR NIH HHS; UL1 RR024989/RR/NCRR NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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