Physical Activity and Hemodynamic Reactivity in Chronic Kidney Disease

Agarwal, Rajiv; Light, Robert P.

doi:10.2215/cjn.02920608

Cited by 24 publications

(26 citation statements)

References 39 publications

(43 reference statements)

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“…Although home BP monitoring is an excellent tool to detect and manage hypertension, it cannot rule out masked hypertension or white-coat hypertension. Physical activity can have a powerful effect on BP, especially in patients with CKD, who are more sedentary, and those who are not treated with antihypertensive drugs (25). Circadian rhythms can be identified only with ABPM.…”

Section: Discussionmentioning

confidence: 99%

Masked Hypertension and White-Coat Hypertension in Chronic Kidney Disease

Bangash

Agarwal

2009

Clinical Journal of the American Society of Nephrology

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131

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Background and objectives: Poor hypertension control observed in patients with chronic kidney disease (CKD) may in part be due to the suboptimal assessment of BP with clinic BP measurements alone. The goal of this meta-analysis was to estimate the prevalence and determinants of white-coat and masked hypertension in the adult CKD population.Design, setting, participants, & measurements: Articles reporting prevalence of masked and white-coat hypertension in patients with CKD were obtained from two major databases. We then performed a meta-analysis to derive pooled estimates of prevalence and determinants of these two conditions.Results: Among 980 patients with CKD identified in six studies, the overall prevalence of masked hypertension was 8.3% and of white-coat hypertension was 18.3%. More alarming, 40.4% of patients who had CKD and were thought to have normotension (or adequately treated hypertension) in fact had hypertension at home. Also 30.0% of patients who had CKD and were thought to have hypertension had normotension at home. The thresholds for classification of clinic and ambulatory BP as hypertensive strongly influenced the risk for diagnosis of masked hypertension in favor of white-coat hypertension.Conclusions: Because clinic BP measurements alone lead to substantial misclassification in BP, we estimate that the prevalence of poorly controlled hypertension is likely less than currently estimated. Out-of-office BP monitoring may improve the management of hypertension in patients with CKD. Standardized definitions for the diagnosis of masked and white-coat hypertension would facilitate research.

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Section: Discussionmentioning

confidence: 99%

Masked Hypertension and White-Coat Hypertension in Chronic Kidney Disease

Bangash

Agarwal

2009

Clinical Journal of the American Society of Nephrology

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131

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“…Exercise improves cardiorespiratory fitness (1), hemodynamic reactivity (2,3), physical fitness (4,5) malnutritioninflammation complex syndrome (6), and quality of life (7) in patients with CKD. A recent study by Wen et al showed that a small amount of exercise, such as 15 minutes a day or 90 minutes a week, may reduce mortality in the general population and individuals with cardiovascular disease (8).…”

Section: Introductionmentioning

confidence: 99%

Association of Walking with Survival and RRT Among Patients with CKD Stages 3–5

Chen

Wang

Liang

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Patients with CKD can benefit from an increase in physical activity. Walking is one of the most common exercises in patients with CKD; however, the association of walking with outcomes in patients with CKD is not clear. This study investigated the association of walking with overall mortality and RRT in patients with CKD stages 3-5.Design, setting, participants, & measurements All patients with CKD stages 3-5 in the CKD program of China Medical University Hospital from June 2003 to May 2013 were enrolled. The risks of overall mortality and RRT were analyzed using competing-risks regressions.Results A total of 6363 patients (average age, 70 years) during a median of 1.3 (range=0.6-2.5) years of follow-up were analyzed. There were 1341 (21.1%) patients who reported walking as their most common form of exercise. The incidence density rate of overall mortality was 2.7 per 100 person-years for walking patients and 5.4 for nonwalking ones. The incidence density rate of RRT was 22 per 100 person-years for walking patients and 32.9 for nonwalking ones. Walking, independent of patients' age, renal function, and comorbidity, was linked to lower overall mortality and lower RRT risk in the multivariate competing-risks regression. The adjusted subdistribution hazard ratio (SHR) of walking was 0.67 (95% confidence interval [95% CI], 0.53 to 0.84; P,0.001) for overall mortality and 0.79 (95% CI, 0.73 to 0.85; P,0.001) for the risk of RRT. The SHRs of overall mortality were 0.83, 0.72, 0.42, and 0.41 for patients walking 1-2, 3-4, 5-6, and $7 times per week, and the SHRs of RRT were 0.81, 0.73, 0.57, and 0.56, respectively.Conclusions Walking is the most popular form of exercise in patients with CKD and is associated with lower risks of overall mortality and RRT. The benefit of walking is independent of patients' age, renal function, and comorbidity.

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“…Given that activity generally increases systolic BP it is surprising that home BP found a higher prevalence of MUCH. 38 However, the act of home BP measurement may be stressful, and readings during the first few hours after waking may be higher than during the rest of the day. 39 This might explain why the prevalence of MUCH detected by home BP recordings was higher.…”

Section: Discussionmentioning

confidence: 99%

Masked Uncontrolled Hypertension in CKD

Agarwal

Pappas

Sinha

2016

Journal of the American Society of Nephrology

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Masked uncontrolled hypertension (MUCH) is diagnosed in patients treated for hypertension who are normotensive in the clinic but hypertensive outside. In this study of 333 veterans with CKD, we prospectively evaluated the prevalence of MUCH as determined by ambulatory BP monitoring using three definitions of hypertension (daytime hypertension $135/85 mmHg; either nighttime hypertension $120/70 mmHg or daytime hypertension; and 24-hour hypertension $130/80 mmHg) or by home BP monitoring (hypertension $135/ 85 mmHg). The prevalence of MUCH was 26.7% by daytime ambulatory BP, 32.8% by 24-hour ambulatory BP, 56.1% by daytime or night-time ambulatory BP, and 50.8% by home BP. To assess the reproducibility of the diagnosis, we repeated these measurements after 4 weeks. Agreement in MUCH diagnosis by ambulatory BP was 75-78% (k coefficient for agreement, 0.44-0.51), depending on the definition used. In contrast, home BP showed an agreement of only 63% and a k coefficient of 0.25. Prevalence of MUCH increased with increasing clinic systolic BP: 2% in the 90-110 mmHg group, 17% in the 110-119 mmHg group, 34% in the 120-129 mmHg group, and 66% in the 130-139 mmHg group. Clinic BP was a good determinant of MUCH (receiver operating characteristic area under the curve 0.82; 95% confidence interval 0.76-0.87). In diagnosing MUCH, home BP was not different from clinic BP. In conclusion, among people with CKD, MUCH is common and reproducible, and should be suspected when clinic BP is in the prehypertensive range. Confirmation of MUCH diagnosis should rely on ambulatory BP monitoring. CKD affects 11% (19.2 million) of the United States adult population; 1,2 among them hypertension occurs in at least 70%. 3 Controlling hypertension is an important strategy to reduce cardiovascular morbidity and mortality and end-stage renal disease. Yet some large randomized trials that have lowered BP have failed to show an improvement in cardiovascular or renal outcomes. [4][5][6] One explanation may be that techniques to assess BP in these patients were suboptimal. Whereas non-traditional risk factors may certainly be important, data from the Framingham Heart Study demonstrate that it is the traditional risk factors that mediate the inflammatory state; this in turn impairs vascular function. 7 Thus, it appears appropriate to refocus our attention on the traditional risk factorssuch as blood pressure-and how to better assess and treat hypertension.Masked hypertension (MHTN), which is defined as normal BP in the clinic but elevated BP at home is seen in 10-20% of the general population that does not receive antihypertensive therapy. 8,9 A meta-analysis of 36 studies incorporating 25,629 participants reported its prevalence as 17%. 10 People receiving antihypertensive therapy who have hypertension out of office but have normal BP in the clinic are said to have masked uncontrolled hypertension (MUCH). In studies of CKD patients, all of which recruited a limited number of patients, a meta-analysis also found a high prevalence of MUCH. 11 Th...

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Physical Activity and Hemodynamic Reactivity in Chronic Kidney Disease

Cited by 24 publications

References 39 publications

Masked Hypertension and White-Coat Hypertension in Chronic Kidney Disease

Masked Hypertension and White-Coat Hypertension in Chronic Kidney Disease

Association of Walking with Survival and RRT Among Patients with CKD Stages 3–5

Masked Uncontrolled Hypertension in CKD

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