Hypertension in Chronic Kidney Disease Part 1

Hypertension is highly prevalent in chronic kidney disease (CKD), particularly in patients with end-stage renal disease (ESRD) receiving hemodialysis. The identification and treatment of hypertension in CKD has to face peculiar problems because of the marked alterations in 24-hour blood pressure (BP) profile, in particular of a reduced BP dipping at night, and the high prevalence of specific hypertension phenotypes, such as white coat (WCH) and masked hypertension (MH). Moreover, the ebb and flow of fluid volume in hemodialysis patients makes a proper assessment and achievement of BP control even more difficult. Although conventional BP measurements (CBP), performed in the office or in the dialysis unit by healthcare personnel, are currently recommended and applied for the diagnosis and management of hypertension in patients with CKD, including those on dialysis, these metrics are intrinsically inaccurate. CBP measurements are known to fail providing reliable estimates of the actual BP burden in several clinical conditions, and this is even more so in CKD and in hemodialysis patients. Thus, in addition to CBP measurements, proper assessment and management of hypertension in these patients should be ideally based also on out-of-office BP measurements, including ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM), as acknowledged by a consensus document by the American Society of Hypertension and the American Society of Nephrology. In this article, we highlight the advantages and disadvantages of out-of-office BP monitoring for the management of arterial hypertension in these conditions, based on a thorough literature search through classical engines, such as Pubmed and Web of Science, supplemented by the authors' own expertise.