Abstract
Both chronic kidney disease (CKD) and masked hypertension (MHT) are known to be linked with an increased risk of cardiovascular disease (CVD), but their relationship has remained unclear. The present study aimed to evaluate the CKD incidence in individuals with MHT in the general Japanese population. We recorded self-measured blood pressure at home (HBP) and casual blood pressure (CBP) in 1,365 individuals (mean 63.0 years old; males, 32.5%; mean creatinine clearance [CCr], 60.9 mL/min; positive proteinuria, 6.7%) and classified the subjects into four groups: sustained normal blood pressure (SNBP, 60.3%), white-coat hypertension (WCHT, 14.9%), MHT (12.8%), and sustained hypertension (SHT, 12.0%). Kidney parameter results for the respective groups (SNBP, WCHT, MHT, and SHT) were as follows: 61.7 mL/min, 61.8 mL/min, 59.6 mL/min, and 57.3 mL/min for CCr, 4.2%, 8.9%, 10.3%, and 12.8% for the prevalence of positive proteinuria, and 2.3%, 3.0%, 6.3%, and 9.8% for the proportion with CCr<60 mL/min with proteinuria. Compared with the SNBP group, the MHT and SHT groups exhibited significant differences in these parameters (p<0.05, for each). The adjusted odds ratios for CCr<60 mL/min with proteinuria were significantly higher in the MHT (2.56) and SHT (3.60) groups compared with the SNBP group (reference). MHT, like SHT, is closely related to CKD, and HBP measurement could be a useful screening strategy to detect CKD in the general population.
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Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY : Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296–1305.
Ninomiya T, Kiyohara Y, Kubo M, et al: Chronic kidney disease and cardiovascular disease in a general Japanese population: the Hisayama Study. Kidney Int 2005; 68: 228–236.
Nakayama M, Metoki H, Terawaki H, et al: Kidney dysfunction as a risk factor for first symptomatic stroke events in a general Japanese population—the Ohasama study. Nephrol Dial Transplant 2007; 22: 1910–1915.
National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39 (Suppl): S1–S246.
Pickering TG, Davidson K, Gerin W, Schwartz JE : Masked hypertension. Hypertension 2002; 40: 795–796.
Bobrie G, Chatellier G, Genes N, et al: Cardiovascular prognosis of “masked hypertension” detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA 2004; 291: 1342–1349.
Ohkubo T, Kikuya M, Metoki H, et al: Prognosis of “masked” hypertension and “white-coat” hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study. J Am Coll Cardiol 2005; 46: 508–515.
Imai Y, Satoh H, Nagai K, et al: Characteristics of a community-based distribution of home blood pressure in Ohasama in northern Japan. J Hypertens 1993; 11: 1441–1449.
Imai Y, Abe K, Sasaki S, et al: Clinical evaluation of semi-automatic devices for home blood pressure measurement: comparison between cuff-oscillometric and microphone methods. J Hypertens 1989; 7: 983–990.
Imai Y, Otsuka K, Kawano Y, et al, on behalf of the Japanese Society of Hypertension: Japanese Society of Hypertension (JSH) guidelines for self-monitoring of blood pressure at home. Hypertens Res 2003; 26: 771–778.
Chonan K, Kikuya M, Araki T, et al: Device for the self-measurement of blood pressure that can monitor blood pressure during sleep. Blood Press Monit 2001; 6: 203–205.
Association for the Advancement of Medical Instrumentation: American National Standards for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP 10–1987). Washington DC, Association for the Advancement of Medical Instrumentation, 1987.
Chobanian AV, Bakris GL, Black HR, et al; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560–2572.
European Society of Hypertension European Society of Cardiology Guidelines Committee: 2003 European Society of Hypertension–European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011–1053.
Japanese Society of Hypertension Guidelines Subcommittee for the Management of Hypertension: Guidelines for the management of hypertension for general practitioners. Hypertens Res 2001; 24: 613–634.
Verdecchia P, Staessen JA, White WB, Imai Y, O'Brien ET : Properly defining white coat hypertension. Eur Heart J 2002; 23: 106–109.
Cockcroft DW, Gault MH : Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31–41.
Takahashi M, Fukuda Y, Iwata S : Fundamental evaluation and efficacy for protein to creatinine ratio by ATLAS kit cartridge PRO12 using automatic urine analyzer Clinitek ATLAS XL. Igaku To Yakugaku 2002; 48: 727–735 (in Japanese).
Terawaki H, Yoshimura K, Hasegawa T, et al: Oxidative stress is enhanced in correlation with renal dysfunction: examination with the redox state of albumin. Kidney Int 2004; 66: 1988–1993.
Halbesma N, Kuiken DS, Brantsma AH, et al: Macroalbuminuria is a better risk marker than low estimated GFR to identify individuals at risk for accelerated GFR loss in population screening. J Am Soc Nephrol 2006; 17: 2582–2590.
Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH : Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 2004; 164: 659–663.
Waldron JS, Baoku Y, Hartland AJ, Anderson NR, Horton R, Gama R : Urine microalbumin excretion in relation to exercise-induced electrocardiographic myocardial ischemia. Med Sci Monit 2002; 8: CR725–CR727.
Irie F, Iso H, Sairenchi T, et al: The relationships of proteinuria, serum creatinine, glomerular filtration rate with cardiovascular disease mortality in Japanese general population. Kidney Int 2006; 69: 1264–1271.
Zanaad F, Matzinger A, Larche J : Trough/peak ratios of once daily angiotensin converting enzyme inhibitor and calcium antagonist. Am J Hypertens 1996; 9: 633–643.
Agarwal R, Andersen MJ : Prognostic importance of clinic and home blood pressure recordings in patients with chronic kidney disease. Kidney Int 2006; 69: 406–411.
Levey AS, Coresh J, Greene T, et al, Chronic Kidney Disease Epidemiology Collaboration: Using standard serum creatinine values in the modification of diet renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145: 247–254.
Du Bois D, Du Bois EF : A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 1916; 17: 863–871.
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Terawaki, H., Metoki, H., Nakayama, M. et al. Masked Hypertension Determined by Self-Measured Blood Pressure at Home and Chronic Kidney Disease in the Japanese General Population: The Ohasama Study. Hypertens Res 31, 2129–2135 (2008). https://doi.org/10.1291/hypres.31.2129
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DOI: https://doi.org/10.1291/hypres.31.2129
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