Masked Hypertension in CKD: Increased Prevalence and Risk for Cardiovascular and Renal Events

PURPOSE OF REVIEW: Hypertension and chronic kidney disease (CKD) are inextricably linked. The causal nature of the relationship is bidirectional. This relationship holds when blood pressure is assessed in the clinic and outside the clinic with home and ambulatory blood pressure monitoring. Patients with CKD are more likely to have high-risk hypertension phenotypes, such as masked and sustained hypertension, and are at increased risk for cardiovascular disease. The purpose of this review is to describe the increased prevalence of masked hypertension in patients with CKD and then describe the increased risk for target organ damage and adverse clinical events associated with masked hypertension in patients with CKD.

RECENT FINDINGS: The prevalence of masked hypertension is greater in patients with CKD than that of the general population. Recent studies have demonstrated that masked hypertension is associated with increased risk for target organ damage including left ventricular hypertrophy, elevated pulse wave velocity, proteinuria, and decreased estimated glomerular filtration rate in patients with CKD. Additionally, in patients with CKD, masked hypertension is associated with increased risk for cardiovascular disease, end-stage renal disease, and all-cause mortality. Patients with CKD are at increased risk for masked hypertension. Masked hypertension is associated with increased risk for target organ damage and adverse cardiovascular and renal outcomes in patients with CKD. Further research is necessary to better understand the pathophysiology of masked hypertension, the optimal method for diagnosing masked hypertension, and to determine whether masked hypertension is a modifiable risk factor.