Changes of blood pressure patterns and target organ damage in patients with chronic kidney disease: results of theAPrODiTe-2 study

Objective: Blood pressure (BP) control is the most established practice for preventing the progression of chronic kidney disease (CKD). We examined the BP control and nocturnal dipping pattern changes in hypertensive patients with CKD and their effects on target organ damages. Methods: We recruited 378 hypertensive CKD patients from four centers in Korea. The patients underwent clinic and ambulatory BP monitoring at the time of enrollment and 1 year later. Results: The BP control states at the two time points were as follows: true controlled (16.5, 17.5%), white-coat (2.9, 0.4%), masked (50.0, 53.3%), and sustained uncontrolled (30.6, 28.8%) hypertension. The dipping states at two time points were as follows: extreme-dipping (11.4, 10.8%), dipping (22.2, 20.5%), nondipping (31.3, 34.7%), and reverse-dipping (35.0, 34.0%). When we divided the patients according to the median estimated glomerular filtration rate (eGFR) and proteinuria changes, more stable changes in eGFR and proteinuria were associated with better (to true controlled and white-coat) initial and follow-up BP control statuses. Moreover, better BP control and dipping (to dipper) changes were also associated with more stable eGFR and proteinuria changes. Good initial and follow-up BP control statuses were associated with less left ventricular hypertrophy. Also, masked and sustained uncontrolled hypertension was associated with more cardio-cerebrovascular events in the univariate analysis. Conclusions: A large majority of Korean hypertensive CKD patients had uncontrolled BP and abnormal dipping patterns. Furthermore, better BP control and dipping status changes were associated with better renal function and proteinuria, and also less cardio-cerebrovascular damages.