Clinic versus home blood-pressure measurements as a predictor of outcomes in chronic kidney disease

Johannes FE Mann* and Karl F Hilgers

This article has no abstract so we have provided the first paragraph of the full text.

Although every paper on CKD emphasizes the importance of blood-pressure control, surprisingly little is known about the optimal blood-pressure level for this population, and whether it is best defined by SBP or DBP, and by home, office or 24 h ambulatory measurements. More data are available from people with primary hypertension. In this setting, cardiovascular risk is better predicted by 24 h blood pressure¹ and home blood pressure² than by casual measurements taken in an office or hospital. Reduction in blood pressure in primary hypertension, however it is defined, invariably reduces cardiovascular risk. In patients with CKD, however, observational data from prospective interventional studies consistently show that SBP, but not DBP, is closely associated with cardiovascular outcomes, total mortality and renal outcomes such as ESRD. Thus, DBP—the main target of most interventional studies in primary hypertension—might not be a valid target in patients with CKD.

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