White-coat hypertension and masked hypertension diagnoses on chronic kidney disease patients

• Grant number: 19/18840-1
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: November 01, 2019
• End date: October 31, 2020
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Luis Cuadrado Martin
• Grantee: Henrique Pereira da Silva
• Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil

Abstract

Background. Arterial hypertension is most prevalent clinical condition in the world. Therefore, its clinical evaluation and correct diagnosis are fundamental. Nevertheless, despite this global importance, the office blood pressure (BP) measurement has its important limitations, which are more often seen on Chronic Kidney Disease (CKD) patients. Taking this into account, there are two different medical diagnosis, related to arterial hypertension, whose tracking cannot be made exclusively at the office. The first one is named masked hypertension: BP normal at the office and hypertensive BP readings from ambulatory blood pressure measurement (ABPM). The other one is called white-coat hypertension, in which office readings are elevated, but ABPM shows no abnormalities. ABPM data selection to compose those definitions is still controversial. Thus, the purpose of this study is to help decide which is the best ABPM criteria to compose the definition of masked hypertension and white-coat hypertension in CKD patients. Methods. This longitudinal and retrospective study will include patients who have undergone ABPM examinations in the period between 01/27/2004 and 02/16/2012. Those patients met CKD criteria: Glomerular filtration ratio below 60 mL/min per 1.73 m² or markers of kidney disease even with preserved glomerular filtration ratio. The following time will be from the ABPM realization to January/2014. ABPM abnormalities will be categorized following these thresholds (SBP stands for systolic blood pressure and DBP refers to diastolic blood pressure): SBP 24h e 130 mm Hg; DBP 24h e 80 mm Hg; daytime SBP e 135 mmHg; daytime DBP e 85 mm Hg; nighttime SBP e 120 mm Hg; nighttime DBP e 70 mm Hg. The two white-coat definitions to be tested are: 1) office BPP e 140/90 mm Hg and daytime ABPM BP < 135/85 mm Hg (old criterion); 2) office BP e 140/90 mmHg and 24h ABPM BP< 130/80 mm Hg, daytime BP< 135/85 mm Hg and nighttime BP < 120/70 mm Hg (new criterion). The two masked hypertension definitions tested were: 1) office BP < 140/90 mm Hg and daytime ABPM BP e 135/85 mm Hg (old criterion). 2) office BP < 140/90 mm Hg and 24h ABPM BP h e 130/80 mm Hg or daytime BP e 135/85 mm Hg or nighttime BP e 120/70 mm Hg (new criterion). Data analysis. Cox regression will be made, considering cardiovascular outcome as the primary one and death by other causes as secondary one. It was compared the two masked and white-coat hypertension definitions capability to predict outcomes. The Cox analyze will be adjusted by disease level, age, diabetes and smoking. The results will be significant to p < 0,05. (AU)

Scientific publications

(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)

DA SILVA, HENRIQUE PEREIRA; GONCALVES, ALESSANDRA BONILHA; BARRETTI, PASQUAL; FRANCO, ROBERTO SILVA; BANIN, VANESSA BURGUGI; SILVA, VANESSA DOS SANTOS; MARTIN, LUIS CUADRADO. White-coat and masked hypertension diagnoses in chronic kidney disease patients. JOURNAL OF CLINICAL HYPERTENSION, v. 22, n. 7, JUL 2020. (19/18840-1)