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Cupisti A, Bruno RM, Puntoni A, Varricchio E, Giglio E, Meniconi O, Zullo C, Barsotti M, Egidi MF, Ghiadoni L. Blood pressure phenotype reproducibility in CKD outpatients: a clinical practice report. Intern Emerg Med 2020; 15:87-93. [PMID: 31209681 DOI: 10.1007/s11739-019-02127-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/06/2019] [Indexed: 11/30/2022]
Abstract
Out-of-office blood pressure (BP) measurement is encouraged by recent hypertension guidelines for assessing BP phenotypes. These showed acceptable reproducibility in the short term, but few data exist about long-term reproducibility, particularly for chronic kidney disease (CKD) patients. We evaluated changes of the BP phenotypes at 6 and 12 months in 280 consecutive non-dialysis CKD outpatients (186 males, age 71 ± 12 years, eGFR 38 ± 13 ml/min/1.73), without any change in drug therapy. Elevated BP is defined as office BP > 140/90 and home BP > 135/85 mmHg for defining the following BP phenotypes: sustained uncontrolled hypertension (SUCH); white-coat uncontrolled hypertension (WUCH); masked uncontrolled hypertension (MUCH); and controlled hypertension (CH). At baseline, the prevalence of the phenotypes was SUCH 36.6%, CH 30.1%, WUCH 25.4% and MUCH 7.9%, and it was similar at 6 months and 12 months. On the other hand, individual phenotype reproducibility at 12 months was poor both overall (38.0%) and across the different phenotypes (SUCH 53.9%, WUCH 32.4% and CH 32.1%, MUCH 9.1%). Patients who were not maintaining the same phenotype (non-concordant) were not distinguished by age, sex, BMI, eGFR, presence of diabetes or cardiovascular disease, or pharmacological therapy. When reproducibility of BP phenotypes both at 6 months and at 12 months was assessed, it was very low (19.6%), particularly for MUCH (0%), CH (14%) and WUCH (15.5%), while it was 31% for SUCH. In a CKD cohort, the overall prevalence of the different BP phenotypes defined by office and home BP remains constant over time. However, only 38% of patients maintained the same phenotype at 12 months, suggesting a poor reproducibility over time for the BP phenotypes.
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Affiliation(s)
- Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126, Pisa, Italy.
| | - R M Bruno
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126, Pisa, Italy
| | - A Puntoni
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126, Pisa, Italy
| | - E Varricchio
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126, Pisa, Italy
| | - E Giglio
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126, Pisa, Italy
| | - O Meniconi
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126, Pisa, Italy
| | - C Zullo
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126, Pisa, Italy
| | - M Barsotti
- Nephrology, Transplants and Dialysis Unity, Pisa University Hospital, via Paradisa, 56126, Pisa, Italy
| | - M F Egidi
- Nephrology, Transplants and Dialysis Unity, Pisa University Hospital, via Paradisa, 56126, Pisa, Italy
| | - L Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126, Pisa, Italy
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