The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Optimal blood pressure target and measurement in patients with chronic kidney disease

  • Kim, Chang Seong (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Choi, Hong Sang (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Bae, Eun Hui (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Soo Wan (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Ma, Seong Kwon (Department of Internal Medicine, Chonnam National University Medical School)
  • Received : 2019.03.18
  • Accepted : 2019.05.19
  • Published : 2019.11.01
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Abstract

The prevalence rates of hypertension and chronic kidney disease (CKD) are increasing with the aging of the population. Hypertension and CKD are closely related, and hypertension with accompanying CKD is difficult to control. This difficulty controlling blood pressure (BP) can be explained by changes in diurnal variation in BP, such as non-dipping and reverse dipping patterns, increased pulse pressure, and BP variability in CKD patients resulting in a high frequency of nocturnal hypertension or masked hypertension. CKD patients with uncontrolled or nocturnal hypertension are at increased risk for cardiovascular disease, progression of CKD, and all-cause death. Recent studies have shown that intensive reduction of systolic BP below 120 mmHg is seems to favor in CKD patients regardless of the presence or absence of diabetes. As BP control is difficult in patients with CKD, appropriate measurement of BP is important. Automated BP monitoring could reduce the so-called "white coat effect" (spike in BP) that may be triggered by measurement in a clinical setting. Moreover, out-of-office BP monitoring at home or ambulatory BP monitoring for 24 hours may provide critical information regarding diurnal BP variability and nocturnal BP in patients with CKD.

Keywords

Acknowledgement

This research was supported by the Bio & Medical Development Program through the NRF of Korea funded by the Ministry of Science and ICT (MSIT) (NRF-2017M3A9E8023018), and by a grant (CRI 18016-1, BCRI18025) Chonnam National University Hospital Biomedical Research Institute.

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