Masked Hypertension in CKD: Increased Prevalence and Risk for Cardiovascular and Renal Events

Babu, Megha; Drawz, Paul

doi:10.1007/s11886-019-1154-4

Cited by 20 publications

(9 citation statements)

References 40 publications

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“…We found that CKD was strongly correlated with increased disease severity (OR: 2.22; 95% CI: 1.14, 4.31), with moderate heterogeneity (I 2 = 38:1%) ( Figure 4). It is interesting to note that patients with CKD often present with anemia, hypertension, and/or cardiovascular disease [17][18][19]; in this respect, we suggest that COVID-19 patients with CKD should be monitored closely.…”

Section: Chronic Kidney Disease and Acute Kidney Injurymentioning

confidence: 97%

Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis

et al. 2020

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The recent outbreak of COVID-19 has been rapidly spreading on a global scale. To date, there is no specific vaccine against the causative virus, SARS-CoV-2, nor is there an effective medicine for treating COVID-19, thus raising concerns with respect to the effect of risk factors such as clinical course and pathophysiological parameters on disease severity and outcome in patients with COVID-19. By extracting and analyzing all available published clinical data, we identified several major clinical characteristics associated with increased disease severity and mortality among patients with COVID-19. Specifically, preexisting chronic conditions such as hypertension, cardiovascular disease, chronic kidney disease, and diabetes are strongly associated with an increased risk of developing severe COVID-19; surprisingly, however, we found no correlation between chronic liver disease and increased disease severity. In addition, we found that both acute cardiac injury and acute kidney injury are highly correlated with an increased risk of COVID-19-related mortality. Given the high risk of comorbidity and the high mortality rate associated with tissue damage, organ function should be monitored closely in patients diagnosed with COVID-19, and this approach should be included when establishing new guidelines for managing these high-risk patients. Moreover, additional clinical data are needed in order to determine whether a supportive therapy can help mitigate the development of severe, potentially fatal complications, and further studies are needed to identify the pathophysiology and the mechanism underlying this novel coronavirus-associated infectious disease. Taken together, these findings provide new insights regarding clinical strategies for improving the management and outcome of patients with COVID-19.

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Section: Chronic Kidney Disease and Acute Kidney Injurymentioning

confidence: 97%

Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis

et al. 2020

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“…Hypertension is another concerning public health problem, which is an independently associated factor for CKD in all investigated subjects, but not in sub-group of DM subjects without MAFLD. As hypertension is a common disease affecting almost all human systems, and a leading cause of CKD, [28][29][30] the risk in the subgroup might have been eliminated by other factors, such as diabetes, hyperuricemia, being overweight.…”

Section: Dovepressmentioning

confidence: 99%

Association Between Metabolic Associated Fatty Liver Disease and Chronic Kidney Disease: A Cross-Sectional Study from NHANES 2017–2018

Deng¹,

Zhao²,

Gong³

2021

DMSO

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In 2020, an international expert consensus proposed a novel concept, defined as metabolic associated fatty liver disease (MAFLD). We aimed to investigate the association between MAFLD and chronic kidney disease (CKD). Methods: A total of 4869 subjects with demographic data, laboratory tests, and ultrasound transient elastography from National Health and Nutrition Examination Surveys of the United States (NHANES) 2017-2018 were included in the study. Statistical analysis was performed to test the independent association between the demographic data, laboratory tests, and non-invasive liver fibrosis scores in subjects with different subgroups of MAFLD. Results: A total of 4869 subjects were identified in the NHANES 2017-2018, of which 1032 (21.2%) subjects were diagnosed with CKD. There was a higher prevalence of CKD in MAFLD subjects than in non-MALFD subjects (22.2% vs 19.1, p=0.048). After 1:1 propensity score matching by gender, age and race, we enrolled 1983 subjects with MAFLD diagnosed based on liver ultrasound transient elastography and 1983 PS-matched subjects without MAFLD. MAFLD was not independently associated with CKD after PSM. Further investigation showed that age (OR: 1.

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“…Masked uncontrolled hypertension (MUCH) has usually been defined as uncontrolled 24-hour or daytime hypertension in the presence of a controlled office BP. [13][14][15][16][17][18][19] Recently, it was reported that the prevalence of nighttime masked hypertension among US adults was 18.8% to 22.7%. 20 However, a similar estimate for patients with CKD is lacking.…”

Section: Introductionmentioning

confidence: 99%

Association of Nighttime Masked Uncontrolled Hypertension With Left Ventricular Hypertrophy and Kidney Function Among Patients with Chronic Kidney Disease Not Receiving Dialysis

Ren

Xie

et al. 2022

JAMA Netw Open

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IMPORTANCE Nighttime hypertension is prevalent and associated with adverse outcomes in patients with chronic kidney disease (CKD), but nighttime hypertension, a subtype of masked uncontrolled hypertension (MUCH), is often undetected among patients with controlled office blood pressure. Little attention has been paid to patients with CKD and nighttime MUCH. OBJECTIVETo investigate the prevalence of nighttime MUCH and its associations with cardiovascular and kidney outcomes in patients with CKD who were not receiving dialysis. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study included patients with nondialysis CKD and hypertension, enrolled in Shanghai, China, from July 2012 through November 2020 and followed up for a median of 39 months. EXPOSURESParticipants were classified as having controlled hypertension, sustained hypertension, and MUCH, which was further divided into isolated nighttime MUCH and day-night MUCH, assessed by office and ambulatory blood pressure monitoring. MAIN OUTCOMES AND MEASURES Left ventricular hypertrophy (LVH) was determined by echocardiography. The composite kidney outcome consisted of end-stage kidney diseases (ESKD) and a reduction of estimated glomerular filtration rate (eGFR) by 50% or more. Logistic and Cox regression assessed the associations of hypertension subtypes with LVH and kidney outcomes. RESULTS The 675 patients (425 [63.0%] men; mean [SD] age, 50.8 [15.9] years; mean [SD] eGFR, 61.6 [29.4] mL/min/1.73 m 2 ) included 125 (19.3%) with controlled hypertension, 244 (37.6%) with MUCH, and 280 (43.1%) sustained hypertension. Among patients with MUCH, 2 (0.8%) had isolated daytime MUCH, 154 (63.1%) had isolated nighttime MUCH, and 88 (36.1%) had day-night MUCH.During a median (IQR) follow-up of 39 (19-64) months, 130 composite kidney events, including 97 ESKD events, occurred. Compared with controlled hypertension, MUCH and sustained hypertension were associated with LVH (eg, MUCH: odds ratio [OR], 2.94; 95% CI, 1.18-7.34; P = .02) and the composite kidney outcome (eg, MUCH: hazard ratio [HR], 4.12; 95% CI, 1.75-9.73; P = .001) after adjustment for age, sex, proteinuria, eGFR, and other baseline risk factors. Multivariate-adjusted associations were also significant between day-night MUCH and LVH (OR, 3.26; 95% CI, and between isolated nighttime MUCH and the composite kidney outcome (HR, 4.27; 95% CI, 1.69-10.77). CONCLUSIONS AND RELEVANCEIn this cohort study, nighttime MUCH was common and associated with LVH and poor kidney outcomes among patients with hypertension and nondialysis CKD. These findings suggest that ambulatory blood pressure monitoring was inadequately used in (continued) Key Points Question Is nighttime masked uncontrolled hypertension (MUCH) in patients with chronic kidney disease (CKD) not receiving dialysis associated with worse cardiovascular and kidney outcomes? Findings In this cohort study of 675 patients with hypertension and nondialysis CKD, approximately one-third of patients had nighttime MUCH, consisting of 13.0% day-night MUCH and 22.8...

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Masked Hypertension in CKD: Increased Prevalence and Risk for Cardiovascular and Renal Events

Cited by 20 publications

References 40 publications

Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis

Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis

Association Between Metabolic Associated Fatty Liver Disease and Chronic Kidney Disease: A Cross-Sectional Study from NHANES 2017–2018

Association of Nighttime Masked Uncontrolled Hypertension With Left Ventricular Hypertrophy and Kidney Function Among Patients with Chronic Kidney Disease Not Receiving Dialysis

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