Predictors Factors of Uncontrolled Masked Hypertension (MUCH) in Patients with Chronic Kidney Disease (CKD)

TL;DR

This study identifies key factors that predict uncontrolled masked hypertension in patients with chronic kidney disease, helping to anticipate risks and complications.

Contribution

The study introduces a predictor model for masked uncontrolled hypertension in CKD patients using clinical and laboratory data.

Findings

Higher diastolic BP and elevated albuminuria were observed in the MUCH group.

DBP ≥75 mmHg, BMI ≤25 Kg/m2, and albuminuria ≥300 mg/g were identified as predictors of MUCH.

Abstract

Background/Objectives: Masked uncontrolled hypertension (MUCH) is a blood pressure phenotype prevalent among chronic kidney disease (CKD) patients. It has been associated with an elevated risk of cardiovascular morbidity and mortality. Identifying MUCH predictor factors in this population is crucial in facilitating anticipation of adverse outcomes and complications. Methods: For a period of 7 years (2017–2023), hypertensive patients presenting CKD and in-office normotension (<140/90 mmHg) were consecutively selected. After ambulatory blood pressure monitoring (ABPM), we classified the patients into controlled hypertension (CH) or MUCH. We used epidemiological, clinical, anthropometric, and laboratory data to develop a predictor model of the MUCH phenotype. Results: From 220 participants, 109 (49.5%) had MUCH (mean age: 60 ± 16 years; 45% men; 35% with obesity). Higher diastolic BP (DBP) values were observed in the MUCH group (72 vs. 75; p = 0.01). In contrast, a higher body mass index was observed in the CH group (26 vs. 28; p < 0.01), while elevated albuminuria was observed in the MUCH group (69 vs. 275; p < 0.01). After multivariate analysis, DBP ≥75 mmHg (Odds Ratio: 1.93, 95%CI 1.03–3.64; p = 0.04), BMI ≤25 Kg/m2 (Odds Ratio: 2.21, 95%CI 1.08–4.52; p = 0.03), and albuminuria ≥ 300 mg/g (Odds Ratio: 3.26, 95%CI 1.71–6.19; p < 0.01) were identified as predictors of MUCH phenotype Conclusions: MUCH is common in patients with arterial hypertension (AH) and CKD. DBP ≥ 75 mmHg, BMI ≤ 25 Kg/m2, and albuminuria ≥ 300 mg/g were predictors of MUCH in these patients.

Figures