Optimal blood pressure target and measurement in patients with chronic kidney disease

• Published in: The Korean journal of internal medicine Vol. 34; no. 6; pp. 1181 - 1187
• Main Authors: Kim, Chang Seong, Choi, Hong Sang, Bae, Eun Hui, Kim, Soo Wan, Ma, Seong Kwon
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Association of Internal Medicine 01.11.2019; 대한내과학회
• Subjects: Antihypertensive Agents - therapeutic use; Blood Pressure - drug effects; Blood Pressure Determination; blood pressure monitoring; Circadian Rhythm; Humans; hypertension; Hypertension - diagnosis; Hypertension - drug therapy; Hypertension - epidemiology; Hypertension - physiopathology; kidney diseases; Predictive Value of Tests; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - physiopathology; Renal Insufficiency, Chronic - therapy; Review; Risk Factors; Time Factors; Treatment Outcome; 내과학; Hypertension; Blood pressure monitoring; Kidney diseases
• ISSN: 1226-3303; 2005-6648
• DOI: 10.3904/kjim.2019.164

The prevalence rates of hypertension and chronic kidney disease (CKD) are increasing with the aging of the population. Hypertension and CKD are closely related, and hypertension with accompanying CKD is difficult to control. This difficulty controlling blood pressure (BP) can be explained by changes in diurnal variation in BP, such as non-dipping and reverse dipping patterns, increased pulse pressure, and BP variability in CKD patients resulting in a high frequency of nocturnal hypertension or masked hypertension. CKD patients with uncontrolled or nocturnal hypertension are at increased risk for cardiovascular disease, progression of CKD, and all-cause death. Recent studies have shown that intensive reduction of systolic BP below 120 mmHg is seems to favor in CKD patients regardless of the presence or absence of diabetes. As BP control is difficult in patients with CKD, appropriate measurement of BP is important. Automated BP monitoring could reduce the so-called "white coat effect" (spike in BP) that may be triggered by measurement in a clinical setting. Moreover, out-of-office BP monitoring at home or ambulatory BP monitoring for 24 hours may provide critical information regarding diurnal BP variability and nocturnal BP in patients with CKD.