The aim of the study is to determine and correlate the prevalence of white coat hypertension [WHT] among hypertensive CKD with their target organ damage evidence by left ventricular hypertrophy [LVH] and carotid intima media thickness [CIMT].Design and Method:
A cross sectional study involving hypertensive CKD patients with MDRD less than 60 mL/min/1.732 who attended the CKD clinic was performed. Demographic data, routine blood investigation and number of antihypertensive medication were recorded. Clinic blood pressure, 24-hr ambulatory blood pressure monitoring [24-h ABPM], electrocardiography and carotid ultrasound measurement were performed.Results:
99 patients (42 male, 57 female) with median age of 62 (14) year-old were recruited. Ethnics backgrounds were 66 (66.7%) Malay, 29 (29.3 %) Chinese, and 4 (4%) Indian. The prevalence of WHT and SHT were 34.3% (34 patients) and 65.7% (65 patients) respectively. Both groups had comparable LVH occurrence, 18 (45%) in WHT Vs 22 (55%) in SHT group (p = 0.066). SHT group had significantly higher median carotid intima thickness 0.8 (0.2) mm compared to 0.6 (0.1) mm in WHT (p = < 0.05).The median eGFR(mL/min/1.73m2) were 32 (18) in WHT vs 28 (19) in SHT (p = 0.247). For non-dippers, 2/3 were SHT and 1/3 were WHT (p = 0.501). Patients with WHT were treated with more anti-hypertensive drugs; 3(2) vs 2(2) (p = 0.252). In comparison to both group, WHT had lower median systolic blood pressure than SHT; 24 -h (122. (12) vs. 149 (22)), daytime (126 (10) vs 151 (23), night time (114. (10) vs 141 (27)) blood pressures [p < 0.05] but similar median clinic systolic blood pressure (p = 0.845).Conclusions:
White coat hypertension is prevalent in CKD. Those with SHT has significantly more thickening of carotid intima.