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Original ArticlesHypertension
You have accessRestricted Access

Variations in 24-Hour BP Profiles in Cohorts of Patients with Kidney Disease around the World

The I-DARE Study

Paul E. Drawz, Roland Brown, Luca De Nicola, Naohiko Fujii, Francis B. Gabbai, Jennifer Gassman, Jiang He, Satoshi Iimuro, James Lash, Roberto Minutolo, Robert A. Phillips, Kyle Rudser, Luis Ruilope, Susan Steigerwalt, Raymond R. Townsend, Dawei Xie, Mahboob Rahman and the CRIC Study Investigators
CJASN September 2018, 13 (9) 1348-1357; DOI: https://doi.org/10.2215/CJN.13181117
Paul E. Drawz
1Divisions of Renal Diseases and Hypertension and
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Roland Brown
2Biostatistics, University of Minnesota, Minneapolis, Minnesota;
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Luca De Nicola
3Division of Nephrology, University of Campania L. Vanvitelli, Naples, Italy;
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Naohiko Fujii
4Nephrology Unit, Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan;
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Francis B. Gabbai
5Division of Nephrology-Hypertension, VA San Diego Healthcare System and University of California, San Diego, California;
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Jennifer Gassman
6Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio;
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Jiang He
7Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;
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Satoshi Iimuro
8Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan;
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James Lash
9Department of Medicine, University of Illinois Chicago, Chicago, Illinois;
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Roberto Minutolo
3Division of Nephrology, University of Campania L. Vanvitelli, Naples, Italy;
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Robert A. Phillips
10Department of Cardiology, Houston Methodist, Houston, Texas;
11Weill Cornell Medical College, New York, New York;
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Kyle Rudser
2Biostatistics, University of Minnesota, Minneapolis, Minnesota;
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Luis Ruilope
12Department of Internal Medicine, Hypertension Unit and Institute of Research, Hospital 12 de Octubre, Madrid, Spain;
13Department Preventive Medicine and Public Health, Universidad Autonoma, Madrid, Spain;
14School of Doctoral Studies and Research, Universidad Europea, Madrid, Spain;
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Susan Steigerwalt
15Department of Medicine, Universidad Europea, Ann Arbor, Michigan;
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Raymond R. Townsend
16Renal, Electrolyte and Hypertension Division and
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Dawei Xie
17Department of Biostatistics, Epidemiology and Informatics and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Mahboob Rahman
18Department of Medicine, Case Western University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
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Abstract

Background and objectives Ambulatory BP is increasingly recognized as a better measure of the risk for adverse outcomes related to hypertension, an important comorbidity in patients with CKD. Varying definitions of white-coat and masked hypertension have made it difficult to evaluate differences in prevalence of these BP patterns across CKD cohorts.

Design, setting, participants, & measurements The International Database of Ambulatory BP in Renal Patients collaborative group established a large database of demographic, clinical, and ambulatory BP data from patients with CKD from cohorts in Italy, Spain, the Chronic Renal Insufficiency Cohort (CRIC) and the African American Study of Kidney Disease and Hypertension Cohort Study (AASK) in the United States, and the CKD Japan Cohort (CKD-JAC). Participants (n=7518) with CKD were included in the present analyses. Cutoffs for defining controlled BP were 140/90 mm Hg for clinic and 130/80 mm Hg for 24-hour ambulatory BP.

Results Among those with controlled clinic BP, compared with CKD-JAC, AASK participants were more likely to have masked hypertension (prevalence ratio [PR], 1.21; 95% confidence interval [95% CI], 1.04 to 1.41) whereas CRIC (PR, 0.82; 0.72 to 0.94), Italian (PR, 0.73; 0.56 to 0.95), and Spanish participants (PR, 0.75; 0.64 to 0.88) were less likely. Among those with elevated clinic BP, AASK participants were more likely to have sustained hypertension (PR, 1.22; 95% CI, 1.13 to 1.32) whereas Italian (PR, 0.78; 0.70 to 0.87) and Spanish participants (PR, 0.89; 0.82 to 0.96) were less likely, although CRIC participants had similar prevalence as CKD-JAC. Prevalence of masked and sustained hypertension was elevated in males, patients with diabetes, participants on four or more antihypertensives, and those with moderate-to-severe proteinuria.

Conclusions In a large, multinational database, the prevalence of masked and sustained hypertension varied across cohorts independent of important comorbidities.

  • hypertension
  • chronic kidney disease
  • ethnicity
  • Masked Hypertension
  • Antihypertensive Agents
  • Prevalence
  • Blood Pressure Monitoring, Ambulatory
  • Cohort Studies
  • White Coat Hypertension
  • blood pressure
  • Renal Insufficiency, Chronic
  • kidney
  • proteinuria
  • Comorbidity
  • diabetes mellitus
  • Received November 27, 2017.
  • Accepted May 24, 2018.
  • Copyright © 2018 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 13 (9)
Clinical Journal of the American Society of Nephrology
Vol. 13, Issue 9
September 07, 2018
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Variations in 24-Hour BP Profiles in Cohorts of Patients with Kidney Disease around the World
Paul E. Drawz, Roland Brown, Luca De Nicola, Naohiko Fujii, Francis B. Gabbai, Jennifer Gassman, Jiang He, Satoshi Iimuro, James Lash, Roberto Minutolo, Robert A. Phillips, Kyle Rudser, Luis Ruilope, Susan Steigerwalt, Raymond R. Townsend, Dawei Xie, Mahboob Rahman, the CRIC Study Investigators
CJASN Sep 2018, 13 (9) 1348-1357; DOI: 10.2215/CJN.13181117

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Variations in 24-Hour BP Profiles in Cohorts of Patients with Kidney Disease around the World
Paul E. Drawz, Roland Brown, Luca De Nicola, Naohiko Fujii, Francis B. Gabbai, Jennifer Gassman, Jiang He, Satoshi Iimuro, James Lash, Roberto Minutolo, Robert A. Phillips, Kyle Rudser, Luis Ruilope, Susan Steigerwalt, Raymond R. Townsend, Dawei Xie, Mahboob Rahman, the CRIC Study Investigators
CJASN Sep 2018, 13 (9) 1348-1357; DOI: 10.2215/CJN.13181117
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Keywords

  • hypertension
  • chronic kidney disease
  • ethnicity
  • Masked Hypertension
  • antihypertensive agents
  • prevalence
  • Blood Pressure Monitoring, Ambulatory
  • cohort studies
  • White Coat Hypertension
  • blood pressure
  • Renal Insufficiency, Chronic
  • kidney
  • proteinuria
  • Comorbidity
  • diabetes mellitus

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