Relationship between antihypertensive drug classes and ambulatory blood pressure profile in patients with chronic kidney disease

Abstract

Ambulatory blood pressure monitoring (ABPM) represents the gold standard for blood pressure (BP) measurement and offers important advantages by revealing abnormal BP pro fi les, such as white coat, masked uncontrolled, and nocturnal hypertension, which cannot be captured by of fi ce BP measurements alone [1, 2]. Among the various ambulatory BP phenotypes, nocturnal hypertension has emerged as one of the strongest predictors of cardiorenal risk and is particularly common in patients with chronic kidney disease (CKD) [3, 4]. Yet despite growing evidence supporting its clinical relevance, nighttime BP remains largely overlooked in routine practice, where therapeutic decisions continue to be driven predominantly by of fi ce BP readings. In this issue, Pasricha et al. report an analysis from the Chronic Renal Insuf fi ciency Cohort (CRIC) examining the relationship between antihypertensive medication classes and ambulatory BP pro fi les in patients with CKD [5]. The study included nearly 1500 individuals with CKD who underwent ABPM and evaluated associations between major antihypertensive drug classes and several BP phenotypes, including masked uncontrolled hypertension, nocturnal hypertension, non-dipping status, and BP variability [5]. The authors observed that renin – angiotensin system (RAS) blockers were associated with lower odds of sustained hypertension and nocturnal hypertension, whereas β -blockers were associated with higher odds of masked uncontrolled hypertension and nocturnal hypertension. Calcium channel blockers (CCBs) were also associated with nocturnal hypertension and non-dipping status, although they appeared to reduce short-term BP