Abstract: FR-PO188

Masked Uncontrolled Hypertension and Target Organ Damage in Patients with CKD

Session Information

Category: Hypertension

  • 1103 Vascular Biology and Dysfunction

Authors

  • Schneider, Markus P., University of Erlangen-Nuremberg, Erlangen, Germany
  • Schmieder, Roland E., University of Erlangen-Nuremberg, Erlangen, Germany
  • Eckardt, Kai-Uwe, University of Erlangen-Nuremberg, Erlangen, Germany
  • Scheppach, Johannes Benedikt, University of Erlangen-Nuremberg, Erlangen, Germany
  • Raff, Ulrike, University of Erlangen-Nuremberg, Erlangen, Germany
  • Janka, Rolf, University of Erlangen-Nuremberg, Erlangen, Germany
  • Wanner, Christoph, University Hospital Würzburg, Wuerzburg, Germany
  • Klink, Thorsten, University Hospital Würzburg, Wuerzburg, Germany
  • Ritter, Christian O, University Medicine of Goettingen, Goettingen, Germany
  • Saritas, Turgay, RWTH University of Aachen, Aachen, Germany
  • Schlieper, Georg, MVZ DaVita Karlstraße, Duesseldorf, Germany
  • Floege, Jürgen, RWTH University of Aachen, Aachen, Germany
Background

Masked uncontrolled hypertension (MUCH), i.e. normal blood pressure (BP) in the office but elevated ambulatory BP, has been associated with target organ damage and increased cardiovascular (CV) events in the general population. However, in patients with chronic kidney disease (CKD), who are exposed to a variety of additional CV risk factors, the role of MUCH for target organ damage is less clear.

Methods

In 305 CKD patients under treatment for arterial hypertension, we compared left ventricular mass (LVM, by magnetic resonance imaging), intima-media thickness (IMT), central augmentation index and pulse wave velocity (cAIx and PWV, Mobil-O-Graph®) between the four BP phenotypes: controlled hypertension (CH, normal office BP and normal ambulatory BP), white coat hypertension (WCH, elevated office BP but normal ambulatory BP), MUCH (normal office BP but elevated ambulatory BP) and sustained uncontrolled hypertension (SUCH, elevated office BP and elevated ambulatory BP).

Results

MUCH was present in 18% of patients (table). LVM, IMT, cAIx and PWV differed between BP phenotypes. LVM was greater in MUCH and SUCH versus CH (*P<0.05 for post-hoc comparisons). IMT was increased only in MUCH versus CH. Similarly, cAIx was increased only in MUCH versus CH. Finally, PWV was increased in WCH, MUCH and SUCH versus CH.

Conclusion

MUCH was found in 1 of 5 patients with mild to moderate CKD, and associated with several features of target organ damage. To identify CKD patients at high risk of subclinical target organ damage and future CV events, ambulatory BP monitoring should be used more frequently.

Target organ damage according to BP phenotype
 CH
(n=124, 41%)
WCH
(n=35, 12%)
MUCH
(n=56, 18%)
SUCH
(n=90, 30%)
P-Value trend
LVM (g)111(61-218)126(72-225)130(79-206)*134(72-216)*<0.001
IMT (mm)0.62(0.32-1.02)0.65(0.37-1.29)0.68(0.32-1.12)*0.62(0.15-1.01)0.017
cAIx (%)22±825±726±6*24±60.025
PWV (m/s)8.1±1.79.0±1.4*9.4±1.6*8.9±1.7*<0.05

Funding

  • Commercial Support