Published: 2018-11-22

Prognostic value of ambulatory blood pressure in chronic kidney disease

S. Senthil Kumar, S. Vithiavathi, P. Parameswaran


Background: Hypertension control is essential to prevent macro vascular complications in patients with chronic kidney disease. Ambulatory Blood Pressure Monitoring (ABPM) is the recognized gold standard for the assessment of hypertension and hence in this study ABPM assessment was done in 50 patients with dialysis dependant CKD to evaluate the adequacy of BP control and prevent adverse events.

Methods: This study is a prospective observational study conducted at Aarupadai Veedu Medical College and Hospital, Pondicherry among hypertensive patients with dialysis dependant CKD patients as per standard criteria. A total of 50 patients participated in this study of both gender after obtaining written consent. Patients with coronary artery disease, diabetes mellitus, acute kidney injury were excluded from this study.

Results: Out of the total 50 patients included in this study 72% had early morning dipping in BP and remaining 28% had non-dipping in systolic and diastolic pressure. The mean systolic pressure reached a maximum of 160.95mmHg to a minimum of 113.38mmHg and the mean diastolic pressure with a maximum of 98.47 to a minimum of 62.71mmHg on an overall 24 hours ABPM monitoring. The mean systolic and diastolic pressure was found to be more in the active period than in the passive period.

Conclusions: Nocturnal BP is superior to day time BP in predicting CVD outcomes. This study shows both systolic and diastolic pressure variability over 24hrs maximum during night hours (nocturnal hypertension) and non-dipping of early morning BP. Both non-dipping status and nocturnal hypertension are associated with target organ damage and CV risk.


Ambulatory blood pressure, Chronic kidney disease, Hypertension

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Victor RG. In: Systemic hypertension: Mechanism and diagnosis: Braunwald’s Heart disease: A Textbook of Cardiovascular Medicine. 9th ed. 2011:935-954.

US Renal Data System. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2010.

Hanratty R, Chonchol M, Havranek EP, Powers JD, Dickinson LM, Ho PM, et al. Relationship between blood pressure and incident chronic kidney disease in hypertensive patients. Clin J Am Soc Nephrol. 2011 Sep 15:CJN-02240311.

Casas JP, Chua W, Loukogeorgakis S, Vallance P, Smeeth L, Hingorani AD, et al. Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on renal outcomes: systematic review and meta-analysis. Lancet. 2005 Dec 10;366(9502):2026-33.

Mancia G, Verdecchia P. Clinical value of ambulatory blood pressure: evidence and limits. Circulation Res. 2015 Mar 13;116(6):1034-45.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Hypertension. 2003;42:1206. Available at:

Clark LA, Denby L, Pregibon D, Harshfield GA, Pickering TG, Blank S, et al. A quantitative analysis of the effects of activity and time of day on the diurnal variations of blood pressure. J Clin Epidemiol. 1987 Jan 1;40(7):671-81.

Panza JA, Epstein SE, Quyyumi AA. Circadian variation in vascular tone and its relation to α-sympathetic vasoconstrictor activity. N Eng J Med. 1991 Oct 3;325(14):986-90.

Somers VK, Dyken ME, Mark AL, Abboud FM. Sympathetic-nerve activity during sleep in normal subjects. N Eng J Med. 1993 Feb 4;328(5):303-7.

Stern N, Sowers JR, McGinty D, Beahm E, Littner M, Catania R, et al. Circadian rhythm of plasma renin activity in older normal and essential hypertensive men: relation with inactive renin, aldosterone, cortisol and REM sleep. J Hypertension. 1986 Oct;4(5):543-50.

Fukuda M, Munemura M, Usami T, Nakao N, Takeuchi O, Kamiya Y, et al. Nocturnal blood pressure is elevated with natriuresis and proteinuria as renal function deteriorates in nephropathy. Kidney Int. 2004 Feb 1;65(2):621-5.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003 May 21;289(19):2560-72.

Vijayakumar N, Rajesh J, Vithiavathi S. Microalbuminuria in non-diabetic hypertensive’s: J Hypertension. 2011 June ;(29):414.

Ramya N, Meera KR. Clinicoechocardiographic study of cardiac abnormalities in chronic kidney disease. Int J Med Sci Clin Invention. 2017;4(11): 3328-34.

Kidney disease improving global outcome (KDIGO) blood pressure work group. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppls. 2012;2:337-414.

Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Eng J Med. 2006 Jun 1;354(22):2368-74.

Pogue V, Rahman M, Lipkowitz M, Toto R, Miller E, Faulkner M, et al. African American study of kidney disease and hypertension collaborative research group. Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease. Hypertension. 2009 Jan;53(1):20-7.

Wang C, Gong WY, Zhang J, Peng H, Tang H, Liu X, Ye ZC, Lou T. Disparate assessment of clinic blood pressure and ambulatory blood pressure in differently aged patients with chronic kidney disease. Int J Cardiol. 2015 Mar 15;183:54-62.