ORIGINAL PAPERS: Therapeutic aspectsEffect of ambulatory blood pressure monitoring guided antihypertensive treatment on renal progression in patients with chronic kidney disease: a randomized comparative studyKim, Yunmia; Kim, Jayounb; Lee, Sung Wooc; Sung, Suahc; Yoo, Tae-Hyund; Lee, Kyu-Becke; Hwang, Young-Hwanf; Kim, Taeheea; Kang, Sun Wooa; Kim, Yeong Hoona; Oh, Kook-HwangAuthor Information aDepartment of Internal Medicine, Inje University Busan Paik Hospital, Busan bMedical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine cDepartment of Internal Medicine, Nowon Eulji Medical Center, Eulji University dDepartment of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine eDepartment of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul fTruewords Dialysis Clinic, Incheon gDepartment of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea Correspondence to Kook-Hwan Oh, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 03080 Seoul, Republic of Korea. Tel: +82 2 2072 0776; fax: +82 2 741 4876; e-mail: [email protected] Abbreviations: ABP, ambulatory blood pressure; ABPM, ambulatory blood pressure monitoring; BP, blood pressure; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; ESRD, end-stage renal disease Received 17 March, 2020 Revised 12 July, 2020 Accepted 16 July, 2020 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com). Journal of Hypertension: February 2021 - Volume 39 - Issue 2 - p 325-332 doi: 10.1097/HJH.0000000000002624 Buy SDC Metrics Abstract Objectives: Adequate blood pressure (BP) control is pivotal for managing chronic kidney disease (CKD). The optimal approach for monitoring BP to delay CKD progression is not yet clear. Methods: Patients with hypertension and CKD stage 3–4 were randomized into ambulatory blood pressure monitoring (ABPM) or office BP groups. All patients had ABPM at baseline and 18 months, and the ABPM group additionally underwent ABPM at 3 and 6 months. Each ABPM result was notified only for the ABPM group. The BP target was daytime ABP less than 135/85 mmHg for the ABPM group and office BP less than 140/90 mmHg for the office BP group. The primary outcome was decrease in estimated glomerular filtration rate (eGFR) during 18 months. Results: A total of 146 patients were randomized into the ABPM (n = 69) and office BP groups (n = 77). Although office BP was comparable in the two groups at baseline, daytime ABP was higher in the ABPM group (median 140 vs. 132 mmHg). Initial eGFR was 35.7 ± 12.5 ml/min per 1.73 m2 in the ABPM group and 34.6 ± 12.0 ml/min per 1.73 m2 in the office BP group. eGFR change was −5.5 [95% confidence interval (95% CI) −7.7 to −3.4] ml/min per 1.73 m2 in the ABPM group and −5.0 (95% CI −6.9 to −3.0) ml/min per 1.73 m2 in the office BP group (P = 0.704). Renal events occurred in 10 patients (15.6%) from the ABPM group and five (7.1%) from the office BP group (P = 0.120). Conclusion: The present study did not show a beneficial effect of ABPM for controlling hypertension in CKD compared with conventional office BP monitoring in terms of renal outcomes. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.