Keywords : Ambulatory blood pressure monitoring
AMBULATORY BLOOD PRESSURE MONITORING IN CHRONIC KIDNEY DISEASE
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 7, Pages 3272-3278
declining glomerular filtration rate (GFR) in Chronic kidney disease. It is also the single most
powerful predictor of cardiovascular (CV) disease and mortality. ABPM allows a serial BP
measurements at specified time intervals throughout a 24-hour period, thereby providing a
better assessment of the normal fluctuations in BP levels associated with a person’s daily
activities and sleep. Hence, ABPM is particularly useful in evaluating the patient with highly
variable BP with wide discrepancies between the BP readings obtained in and outside office.
The association between masked hypertension and lower eGFR was observed only in those
participants with elevated night-time BP. In this study, we aimed to determine the effect of
circadian rhythm over hypertension in CKD and non-CKD patients and the associated
prognostic value by assessing the target organ damage.
MATERIALS AND METHODS:
This is a prospective observational study after enlisting inclusion and exclusion criteria
conducted at a tertiary care centre on 60 patients after obtaining written consent, of whom 30
had CKD and 30 controls were hypertensives not having CKD. ABPM machine
was tied to the case and control and blood pressure was measured at intervals of every 30
minutes during the morning hours and hourly during the night.
Out of the total 60 patients included in this study, the CKD group showed 53.33% were reverse dippers, 33.33% non-dippers, 13.3% were dippers while the control group showed 76.6%% were dippers, 16.7% were non-dippers, 6.7% being reverse dippers. The Mean SBP being 157.03 + 16.89 in the case group, while it was 136.33 + 10.75 in the control group (p value>0.001), Mean DBP being 85.57 + 13.09, and in the control group being 82.50 (p value<0.331). The mean systolic and diastolic pressure was found to be more in the passive period than in the active period.
ABPM has enabled a more comprehensive estimate of a patient and true BP and its adverse
outcomes. Nocturnal BP is superior to day-time BP in predicting CVD outcomes. This study
shows both systolic and diastolic pressure variability over 24hrs maximum during night hours
(nocturnal hypertension) and non-dipping of early morning BP in CKD. Both Reverse and
non-dipping status are associated with increased risk of target organ damage and CV risk