Changes in Ambulatory Blood Pressure Monitoring Parameters in Patients with Hypertension and Chronic Kidney Disease

Background: Current research has indicated that 24-hour ambulatory blood pressure monitoring (ABPM) is more effective than clinic blood pressure (BP) assessment in predicting cardiovascular outcomes and targeting organ damage. Our study aimed to analyze 24-hour ABPM patterns in patients with arterial hypertension (AH) and chronic kidney disease (CKD). Methods and Results: This retrospective study included 1,000 patients (440 men and 560 women) aged 62.81 +/- 10.31 years with AH grades 1-3 (ESC/ESH, 2018) and CKD stages G1-G4. CKD stages were classified based on the GFR category (G1, G2, G3a, G3b, G4) (KDIGO 2012). All patients underwent an assessment of traditional risk factors, physical examination, clinical and biochemical laboratory methods, 12-lead ECG, and echocardiography. The 24-hour ABPM was performed using a Medicom Combi device (Russia). Depending on renal function, AH patients were divided into three groups: Group 1 included 220 AH patients with CKD G1 (eGFR>90 mL/min/1.73 m(2)), Group 2 group included 512 AH patients with CKD G2 (eGFR 60-89 mL/min/1.73 m(2)), and Group 3 included 268 AH patients with CKD G3a-G4 (eGFR 15-59 mL/min/1.73 m(2)). The average 24-hour SBP and DBP, daytime SBP, and nighttime SBP and DBP increased with worsening CKD stage with maximal values in CKD G3a-G4 (P=0.0000 in all cases). Nocturnal SBP decline was reduced to a greater extent in CKD G3a-G4 (P=0.0000). When assessing nocturnal SBP decrease (dipping), we found a "non-dipper" variant prevailed in all CKD groups. Patients with CKD G3a-G4 had a higher percentage of non-dipping status than those with CKD G1 (58.3% vs. 56.9%), and a "riser" variant was also higher (25.2% vs. 22.0%). Still, the relationship between the CKD stage and dipping status was not statistically significant (P>0.05 in both cases). Conclusion: The worsening CKD stage in AH patients is associated with a severely impaired diurnal blood pressure profile. The presence of CKD requires the mandatory use of ABPM for correct diagnosis and assessment of cardiovascular disease risk.