Vol.:(0123456789) 1 3 Internal and Emergency Medicine https://doi.org/10.1007/s11739-019-02127-y IM - ORIGINAL Blood pressure phenotype reproducibility in CKD outpatients: a clinical practice report Adamasco Cupisti 1  · R. M. Bruno 1  · A. Puntoni 1  · E. Varricchio 1  · E. Giglio 1  · O. Meniconi 1  · C. Zullo 1  · M. Barsotti 2  · M. F. Egidi 2  · L. Ghiadoni 1 Received: 11 February 2019 / Accepted: 6 June 2019 © Società Italiana di Medicina Interna (SIMI) 2019 Abstract Out-of-ofce blood pressure (BP) measurement is encouraged by recent hypertension guidelines for assessing BP phenotypes. These showed acceptable reproducibility in the short term, but few data exist about long-term reproducibility, particularly for chronic kidney disease (CKD) patients. We evaluated changes of the BP phenotypes at 6 and 12 months in 280 consecu- tive non-dialysis CKD outpatients (186 males, age 71 ± 12 years, eGFR 38 ± 13 ml/min/1.73), without any change in drug therapy. Elevated BP is defned as ofce BP > 140/90 and home BP > 135/85 mmHg for defning the following BP pheno- types: sustained uncontrolled hypertension (SUCH); white-coat uncontrolled hypertension (WUCH); masked uncontrolled hypertension (MUCH); and controlled hypertension (CH). At baseline, the prevalence of the phenotypes was SUCH 36.6%, CH 30.1%, WUCH 25.4% and MUCH 7.9%, and it was similar at 6 months and 12 months. On the other hand, individual phenotype reproducibility at 12 months was poor both overall (38.0%) and across the diferent phenotypes (SUCH 53.9%, WUCH 32.4% and CH 32.1%, MUCH 9.1%). Patients who were not maintaining the same phenotype (non-concordant) were not distinguished by age, sex, BMI, eGFR, presence of diabetes or cardiovascular disease, or pharmacological therapy. When reproducibility of BP phenotypes both at 6 months and at 12 months was assessed, it was very low (19.6%), particularly for MUCH (0%), CH (14%) and WUCH (15.5%), while it was 31% for SUCH. In a CKD cohort, the overall prevalence of the diferent BP phenotypes defned by ofce and home BP remains constant over time. However, only 38% of patients maintained the same phenotype at 12 months, suggesting a poor reproducibility over time for the BP phenotypes. Keywords Blood pressure · Hypertension · Phenotypes · CKD · Reproducibility Introduction Blood pressure (BP) control in patients with chronic kidney disease (CKD) is crucial for lowering the progressive loss of renal function and the risk of mortality [1]. The recent European guidelines on the management of hypertension [2] introduced the new concept of a wider use of out-of-ofce BP measurement, especially home BP, as an option to confrm the diagnosis of hypertension, detect white-coat and masked hypertension, and monitor BP con- trol. These terms were originally used to defne subjects independently of anti-hypertensive treatment, while in the most recent European Hypertension Guidelines they identify patients with discrepancies between ofce and out-of-ofce BP in patients not treated for hypertension [2]. In treated hypertensive patients, masked uncontrolled hypertension (MUCH) is characterized by controlled ofce BP but elevated out-of-ofce BP; white-coat uncontrolled hypertension (WUCH) by elevated ofce BP but controlled out-of-office BP; sustained uncontrolled hypertension (SUCH) by elevated both ofce and out-of-ofce BP [2, 3]. These diferent phenotypes have been associated with diferent prognostic signifcance. In the general population and in untreated hypertensive patients, particularly masked hypertension is associated with increased risk of unfavorable outcomes with respect to normotension [4, 5]. It occurs also when treated hypertensive patients were considered [3, 6, 7]. The few available longitudinal studies confirm that the detection of MUCH has prognostic value also in CKD * Adamasco Cupisti adamasco.cupisti@med.unipi.it 1 Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126 Pisa, Italy 2 Nephrology, Transplants and Dialysis Unity, Pisa University Hospital, via Paradisa, 56126 Pisa, Italy