Kidney Research and Clinical Practice 2020 Mar; 39(1): 70-80  
Association of ambulatory blood pressure monitoring with renal outcome in patients with chronic kidney disease
Hyung Eun Son1 , Ji Young Ryu1 , Suryeong Go1 , Youngjin Yi1 , Kipyo Kim2 , Yoon Kyu Oh3,5 , Kook-Hwan Oh4,5 , Ho Jun Chin1,5
1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
2Department of Internal Medicine, Inha University Hospital, Incheon, Republic of Korea
3Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
4Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
5Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
Correspondence to: Ho Jun Chin
Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Republic of Korea. E-mail: mednep@hanmail.net

Edited by Dong-Ryeol Ryu, Ewha Womans University, Seoul, Republic of Korea
Received: September 24, 2019; Revised: November 23, 2019; Accepted: December 3, 2019; Published online: March 31, 2020.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: The significance of ambulatory blood pressure (ABP) in Korean patients with chronic kidney disease (CKD) in relation to renal outcome or death remains unclear. We investigated the role of ABP in predicting end-stage renal disease or death in patients with CKD.
Methods: We enrolled 387 patients with hypertension and CKD who underwent ABP monitoring and were followed for 1 year. Data on clinical parameters and outcomes from August 2014 to May 2018 were retrospectively collected. The composite endpoint was end-stage renal disease or death. Patients were grouped according to the mean ABP.
Results: There were 66 endpoint events, 52 end-stage renal disease cases, and 15 mortalities. Among all patients, one developed end-stage renal disease and died. Mean ABP in the systolic and diastolic phases were risk factors for the development of composite outcome with hazard ratios of 1.03 (95% confidence interval [CI], 1.01-1.04; P < 0.001) and 1.04 (95% CI, 1.02-1.07; P = 0.001) for every 1 mmHg increase in BP, respectively. Patients with mean ABP between 125/75 and 130/80 mmHg had a 2.56-fold higher risk for the development of composite outcome (95% CI, 0.72-9.12; P = 0.147) as compared to those with mean ABP ≤ 125/75 mmHg. Patients with mean ABP ≥ 130/80 mmHg had a 4.79-fold higher risk (95% CI, 1.68-13.70; P = 0.003) compared to those with mean ABP ≤ 125/75 mmHg. Office blood pressure (OBP) was not a risk factor for the composite outcome when adjusted for covariates.
Conclusion: In contrast to OBP, ABP was a significant risk factor for end-stage renal disease or death in CKD patients.
Keywords: Blood pressure monitoring, ambulatory, Hypertension, Kidney failure, chronic


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