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NDT Advance Access originally published online on April 9, 2007
Nephrology Dialysis Transplantation 2007 22(8):2217-2223; doi:10.1093/ndt/gfm164
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Prevalence and clinical correlates of white coat hypertension in chronic kidney disease

Roberto Minutolo1, Silvio Borrelli1, Raffaele Scigliano1, Vincenzo Bellizzi2, Paolo Chiodini3, Bruno Cianciaruso4, Felice Nappi5, Pasquale Zamboli1, Giuseppe Conte1 and Luca De Nicola1

1Department of Nephrology, Second University of Naples, 2Nephrology Unit, County Hospital Solofra, 3Department of Medicine and Public Health-Research Center for Cardiovascular Disease at Second University of Naples, 4Department of Nephrology, University Federico II Naples and 5Nephrology Unit, County Hospital Nola, Italy

Correspondence and offprint requests to: Prof. Roberto Minutolo, MD, Department of Nephrology, Second University of Naples, Via Tiberio 90 I-80125, Naples, Italy. Email: roberto.minutolo{at}unina2.it



  Abstract

Background. The role of white coat hypertension (WCH) in the poor control of blood pressure (BP) in chronic kidney disease (CKD) is ill defined.

Methods. We measured systolic clinical (CBP) and ambulatory blood pressure (ABP) in 290 consecutive patients with non-dialysis CKD [glomerular filtration rate (GFR) <60 ml/min/1.73 m2]. We defined normotension (NOR) if CBP and daytime ABP <130 mmHg, sustained hypertension (SH) when both BP ≥130 mmHg, WCH if only daytime ABP <130 mmHg, and masked hypertension (MH) when only CBP <130 mmHg.

Results. NOR patients were 15.5%, WCH 31.7%, SH 46.9% and MH 5.9%. Due to the high prevalence of WCH, achievement of BP target (<130 mmHg) was more than doubled by daytime ABP than CBP (47.2 vs 21.4%). WCH was characterized by prevalence of diabetes (31.5%), left ventricular hypertrophy (LVH; 50.0%) and CBP values (146 ± 12 mmHg) lower than in SH (41.9%, 71.3% and 158 ± 18 mmHg) but greater than in NOR (17.8%, 37.8% and 118 ± 7 mmHg). Among patients with CBP ≥130 mmHg, the independent risk of having SH rather than WCH increased in the presence of higher CBP [Odds ration (OR) 1.61, 95% confidence intervals (CI) 1.29–2.02], LVH (OR 1.94, 95% CI 1.03–3.63) and proteinuria (OR 3.12, 95% CI 1.31–7.43). In the WCH group, 24 h, daytime and nighttime ABP were 118 ± 7/68 ± 8, 120 ± 7/71 ± 8 and 112 ± 12/63 ± 9 mmHg, respectively.

Conclusions. In CKD, WCH is highly prevalent and can be predicted in the absence of higher CBP, LVH and proteinuria. In these patients, pursuing a low BP target may not be safe because of the risk of cardio–renal hypoperfusion especially at nighttime.

Keywords: ambulatory blood pressure monitoring; cardiovascular risk; chronic kidney disease; hypertension; white coat hypertension

Received for publication: 23. 1.07
Accepted in revised form: 5. 3.07


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