Ambulatory blood pressure and cardiovascular risk in chronic kidney disease

Diagnosis of hypertension is critically dependent on accurate blood pressure (BP) measurement, especially in patients with chronic kidney disease (CKD), in whom early antihypertensive treatment is imperative to prevent cardiovascular events. Ambulatory BP monitoring (ABPM) has successfully identified hypertensive patients at increased risk, but its role in management of CKD patients is not well defined. Loss of the nocturnal decline in BP, which is common in CKD, is associated with adverse cardiovascular events. Increased BP variability has been documented as related to worse outcome, and patients on dialysis are subject to marked BP swings. Traditional measurement in the office fails to provide a thorough picture of the 24-hour BP pattern in CKD patients. Thus, ABPM appears mandatory to better define the hypertensive status in these subjects because it provides information on diurnal BP rhythm and variability and allows identification of subjects with white-coat and masked hypertension.