Blood pressure (BP) control is the most established practice for preventing the progression of chronic kidney disease (CKD). We examined the BP control and nocturnal dipping pattern change in hypertensive patients with CKD and its effects on target organ damages.Design and Method:
We recruited 378 hypertensive CKD patients from 4 centers in Korea. They underwent office and ambulatory BP monitoring at the time of enrollment and 1 year after. High office and ambulatory BP was defined as > 140/90 mmHg and > 135/85 mmHg (daytime)/> 120/70 mmHg (nighttime), respectively.Results:
The BP control state at 2 time points were as follows: true controlled (14.8, 17.5%), white-coat (2.6, 0.4%), masked (45.0, 53.3%), and sustained uncontrolled (27.5, 28.8%) hypertension. The dipping state at 2 time points were as follows: extreme -dipping (11.4, 10.8%), dipping (22.2, 20.5%), non-dipping (31.3, 34.7%), and reverse -dipping (35.0, 34.0%). Better change (to true controlled and white-coat) of BP control status was associated with lower initial level of serum uric acid, urea nitrogen, and proteinuria and higher estimated GFR (eGFR). When we divided patients according to the median of eGFR and proteinuria change, more stable change of eGFR and proteinuria was associated with better initial and follow-up BP control status. And better BP control and dipping status (to dipper) change was also associated with more stable eGFR and proteinuria change. Good initial and follow-up BP control status was associated with less LVH. And masked and sustained uncontrolled hypertension was associated with more congestive heart failure and stroke.Conclusions:
The large majority of Korean hypertensive CKD patients had uncontrolled BP and abnormal dipping pattern. And better BP control and dipping status change was associated with better renal function and proteinuria as well as less cardio-cerebrovascular damages.