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Invited Commentary |

Ambulatory Blood Pressure Measurements in Chronic Kidney Disease: Ready to (Rock and) Roll?  Comment on “Prognostic Role of Ambulatory Blood Pressure Measurement in Patients with Nondialysis Chronic Kidney Disease”

David Goldsmith, FRCP; Adrian Covic, MD, PhD, FRCP(Lond), FASN
Arch Intern Med. 2011;171(12):1098-1099. doi:10.1001/archinternmed.2011.216.
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Blood pressure is very important for the large numbers of people who are now thought to have CKD—around 13% of the US population from the latest National Health and Nutrition Examination Survey report,1 with attendant cardiovascular risk becoming observable after quite small reductions in GFR.2

In nephrology, we do therefore appreciate that renal and cardiovascular risk are heavily intertwined and share several copromoting mechanisms (eg, elevated BP, proteinuria, and dyslipidemia); discovering and properly addressing these matters is a health care priority. Patients with CKD die of cardiovascular disease as much as, or more often than, their disease progresses to requiring dialysis; the “survivors” then reach dialysis, where again it is cardiovascular disease that primarily causes their demise.3 The evidence that treating BP helps to reduce renal progression and attendant cardiovascular disease is strong, although far too much uncertainty remains about what target BP value to aim for, what interventions work best, and whether the known abnormalities in diurnal BP rhythm in CKD are of any prognostic importance.4 This uncertainty has been partially obscured by surprisingly robust guideline recommendations.

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