Effect of Renal Disease on Ambulatory Blood Pressure Monitoring

pp 124-129

Abstract

Background: Chronic renal disease is a growing public health problem, not only for its progression to end-stage renal failure but for its close association with cardiovascular disease, especially hypertension. Currently, there is scarce information on ambulatory blood pressure monitoring (ABPM) in hypertensive patients with renal failure.
Objective: The aim of this study was to assess ABPM pulse pressure, circadian rhythm and blood pressure variability in a population of hypertensive patients with renal failure.
Methods: A cross-sectional study evaluated 123 consecutive ABPM performed in a Hypertension Service. The glomerular filtration rate was estimated using the abridged formula from the “Modification of diet in renal disease” (MDRD) study.
Results: A total of 123 hypertensive patients were evaluated (age 66±7.5 years, 56% men), whose glomerular filtration rate was 64.5±19.4 ml/min/1.73m2 Thirty-seven percent of patients presented with renal failure with a glomerular filtration rate of 45±12.5 ml/min/1.73m2 vs. 76±11.9 ml/min/1.73m2 in patients without renal failure. Fifty-five hypertensive patients (44%) had elevated pulse pressure: 28 (60.9%) with renal failure vs. 27 (35%) without renal failure (p<0.005). After adjusting for different variables, this difference remained significant. No differences were found in blood pressure variability or in the presence of non-dipper pattern.
Conclusions: The main ABPM characteristic in hypertensive patients with renal failure was a significant increase of pulse pressure. There was no greater prevalence of non-dipper pattern or increased blood pressure variability, as classically described for the general population of renal disease patients.