Evaluation of ambulatory blood pressure monitorization results in polycystic kidney patients

Introduction and Aim: Hypertension (HT) is common in autosomal dominant polycystic kidney disease (ADPKD) and is associated with increased total renal volume, activation of the renin-angiotensin-aldosterone system, and progression of renal disease. HT has been reported to occur in 50-75% of individuals with ADPKD early before the onset of significant renal failure, and it is associated with progression to end-stage renal disease (ESRD) and death from cardiovascular causes. Variations in blood pressure (BP) are called BP variability. Current studies have shown that BP variability is associated with increased target organ damage and cardiovascular events. In this study, we aimed to evaluate hypertension, which is an important progression factor in ADPKD, by 24-hour ambulatory blood pressure measurement (ABPM) and to show BP variability, dipping status, uncontrolled, white coat and masked hypertension frequency in these population. Material-method: A total of 100 hypertensive patients (age, sex, and estimated glomerular filtration rate (e-GFR) levels matched 50 ADPKD and 50 diabetic nephtopathy patients) were included in the cross-sectional study. All patients underwent 24-hour ABPM. Demographic and laboratory data were obtained from hospital registry system by examining patient files. Systolic and diastolic BP values (mean daytime, night, 24 hour total) of all patients were recorded. Blood pressure variability coefficients (BP-VC) were calculated separately for both systolic (SBP-VC), diastolic (DBP-VC) and mean arterial blood pressures (MAP-VC). Estimated e-GFR (ml/min) values of patients were calculated with MDRD formula. Results: A total of 100 hypertensive patients (50 patients with ADPKD and 50 patients with diabetic nephropathy) were included in this study. The groups were similar in terms of age, gender, BMI and type of antihypertensive drugs. The mean age of all vi patients was 56.3 ± 11.4 (min: 17-max: 76) years and 54% were male. Uncontrolled HT was present in 62% of the patients (equal in both groups). There was no difference between the groups in terms of the frequency of white coat HT and masked HT. However, non-dipper HT pattern was found to be significantly more frequent in ADPKD group (90%) compared with diabetics (58%). 24 hour ABPM and BP variability values of all patients included in the study were as follows: mean daytime SBP: 133.2 ± 17.8 (min: 98-max: 184) mm Hg, mean daytime SBP-VC: 11.9 ± 2.6 (min: 6.8-max: 18.9), mean night SBP: 130.3±18.6 (min:86-max:178) mm Hg, mean night SBP-VC: 9.9±3.2 (min:4.1-max:21.2), mean 24 hour total SBP: 132.5±17.4 (min:99-max:175) mm Hg and mean 24 hour total SBP-VC: 12.0±2.4 (min:7.1max:17.8), mean daytime DBP: 83.9±12.4 (min:51-max:110) mm Hg, mean daytime DBP-VC: 13.8±3.4 (min:5.7-max:26.1), mean night DBP: 81.9±13.3 (min:43-max:129) mm Hg, mean night DBP-VC: 11.6±3.4 (min:4.1-max:24.9), mean 24 hour total DBP: 83.5±12.0 (min:51-max:116) mm Hg and mean 24 hour total DBP-VC: 14.1±3.0 (min:7.3-max:25.7). Compared with diabetic group, daytime SBP-VK, 24 hour total SBP-VK, daytime MAP-VK and 24 hour total MAP-VK values were significantly lower and mean night DBP values were significantly higher in ADPKD group. There were no statistically significant difference between the two groups in terms of mean daytime SBP, mean night SBP and SBP-VC, mean 24 hour total SBP, mean daytime DBP and DBP-VC, mean night DBP-VC, mean 24 hour total DBP and DBP-VC, mean daytime MAP, mean night MAP and MAP-VC and mean 24 hour total MAP values (p>0.05). Conclusion: Uncontrolled HT is a common problem in patients with ADPKD and diabetic nephropathy. There was no difference between the two groups in terms of the frequency of uncontrolled HT, white coat HT and masked HT. Non-dipper HT pattern was more frequent in ADPKD, whereas blood pressure variability was significantly higher in patients with diabetic nephropathy.