Research Snapshot: Chronic Kidney Disease Linked to Masked Hypertension

Chronic kidney disease (CKD) patients could be suffering from masked hypertension, a recent UMN study found.

This type of undiagnosed high blood pressure can be difficult to spot because patients’ numbers come back normal in the clinic. But outside of the doctor’s office, they could have high blood pressure.

“Masked hypertension is a serious problem,” said Paul Drawz, M.D., lead author of the study. “Hypertension puts you at an increased risk for renal and cardiovascular damage. But if it’s not evident in the clinic, patients won’t get the treatment or preventative care that normally comes along with a hypertension diagnosis.”

Drawz is an assistant professor in the division of renal diseases and hypertension in the Medical School.

The study looked at more than 1,000 men and women with CKD who were enrolled in the Chronic Renal Insufficiency Cohort Study. Each patient received 24-hour ambulatory blood pressure monitoring, which can track spikes in blood pressure over the course of the day. More than one-quarter of the study participants had masked hypertension.

The study found that ambulatory blood pressure better demonstrated the association between high blood pressure and hypertension related target organ damage than blood pressure monitoring in clinic alone. Ambulatory blood pressure therefore could be useful as a prognostic tool, and it should be further studied for its effectiveness in identifying patients at high risk for adverse outcomes.

“We also found that patients with CKD had higher nighttime blood pressure,” Drawz said, which is another risk factor for cardiovascular and renal diseases.

“We need further research to determine whether treating masked hypertension is even feasible,” Drawz said. That could mean more ambulatory blood pressure monitoring, which requires that individuals wear a monitor for 24-hours, and could be more difficult on a mass scale.

More research could help determine whether treatment of masked hypertension would reduce the risk for adverse outcomes because there haven’t been clinical trials with masked hypertension patients.

“This is an opportunity for physicians and health care leaders to take a step back and really consider how we diagnose and treat hypertension, and explore if there are ways we can improve our current standards,” Drawz said.

The study was published in the Clinical Journal of the American Society of Nephrology. The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).