White-coat hypertension and incident end-stage renal disease in patients with non-dialysis chronic kidney disease: results from the C-STRIDE Study

Qin Wang, Yu Wang, Jinwei Wang, Luxia Zhang, Ming-Hui Zhao, Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE), Ming-Hui Zhao, Luxia Zhang, Xiaoqin Wang, Jun Yuan, Qiaoling Zhou, Qiongjing Yuan, Menghua Chen, Xiaoling Zhou, Shuxia Fu, Shaomei Li, Yan Zha, Rongsai Huang, Zhangsuo Liu, JunJun Zhang, Li Wang, Lei Pu, Jian Liu, Suhua Li, Zuying Xiong, Wei Liang, Jinghong Zhao, Jiao Mu, Xiyan Lian, Yunjuan Liao, Hua Gan, Liping Liao, Rong Wang, Zhimei Lv, Yunhua Liao, Ling Pan, Xiaoping Yang, Zhifeng Lin, Zongwu Tong, Yun Zhu, Qiang He, Fuquan Wu, Rong Li, Kai Rong, Caili Wang, Yanhui Zhang, Yue Wang, Wen Tang, Hua Wu, Ban Zhao, Rongshan Li, Lihua Wang, Detian Li, Feng Du, Yonggui Wu, Wei Zhang, Shan Lin, Pengcheng Xu, Hongli Lin, Zhao Hu, Fei Pei, Haisong Zhang, Yan Gao, Luying Sun, Xia Li, Wenke Wang, Fengling Lv, Deguang Wang, Xuerong Wang, Dongmei Xu, Lijun Tang, Yingchun Ma, Tingting Wang, Ping Fu, Tingli Wang, Changying Xing, Chengning Zhang, Xudong Xu, Haidong He, Xiaohui Liao, Shuqin Xie, Guicai Hu, Lan Huang, Qin Wang, Yu Wang, Jinwei Wang, Luxia Zhang, Ming-Hui Zhao, Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE), Ming-Hui Zhao, Luxia Zhang, Xiaoqin Wang, Jun Yuan, Qiaoling Zhou, Qiongjing Yuan, Menghua Chen, Xiaoling Zhou, Shuxia Fu, Shaomei Li, Yan Zha, Rongsai Huang, Zhangsuo Liu, JunJun Zhang, Li Wang, Lei Pu, Jian Liu, Suhua Li, Zuying Xiong, Wei Liang, Jinghong Zhao, Jiao Mu, Xiyan Lian, Yunjuan Liao, Hua Gan, Liping Liao, Rong Wang, Zhimei Lv, Yunhua Liao, Ling Pan, Xiaoping Yang, Zhifeng Lin, Zongwu Tong, Yun Zhu, Qiang He, Fuquan Wu, Rong Li, Kai Rong, Caili Wang, Yanhui Zhang, Yue Wang, Wen Tang, Hua Wu, Ban Zhao, Rongshan Li, Lihua Wang, Detian Li, Feng Du, Yonggui Wu, Wei Zhang, Shan Lin, Pengcheng Xu, Hongli Lin, Zhao Hu, Fei Pei, Haisong Zhang, Yan Gao, Luying Sun, Xia Li, Wenke Wang, Fengling Lv, Deguang Wang, Xuerong Wang, Dongmei Xu, Lijun Tang, Yingchun Ma, Tingting Wang, Ping Fu, Tingli Wang, Changying Xing, Chengning Zhang, Xudong Xu, Haidong He, Xiaohui Liao, Shuqin Xie, Guicai Hu, Lan Huang

Abstract

Background: Controversy remains whether white coat hypertension (WCH) is associated with renal prognosis in patients with chronic kidney disease (CKD).

Methods: In the present multicenter, prospective study, we analyzed data of participants with CKD stage 1-4 from the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE). WCH was defined according to two criteria as follows: A, clinical blood pressure (BP) ≥ 140/90 mm Hg and average 24-h ambulatory BP < 130/80 mm Hg; B, clinical BP ≥ 130/80 mm Hg and daytime ambulatory BP < 130/80 mm Hg. Renal outcome was defined as initiation of renal replacement therapy. The association of WCH with renal events was evaluated by Cox regression model.

Results: A total of 1714 patients with CKD were included in the present analysis. The mean age of the population was 48.9 ± 13.8 years and 56.8% were men. The mean baseline estimated glomerular filtration rate (eGFR) was 52.2 ± 30.1 ml/min/1.73 m2 and urinary protein was 1.0 (0.4, 2.4) g/day. The overall prevalence of WCH was 4.7% and 16.6% according to criteria A and B, respectively. Incidence rates of renal events were 49.58 and 26.51 according to criteria A and B, respectively, per 1000 person-years during a median follow-up of 4.8 years. After full adjustment, WCH was associated with an increased risk of renal event (criterion A: hazard ratio 2.36, 95% confidence interval 1.29-4.34; for criterion B: hazard ratio 1.90, 95% confidence interval 1.04-3.49) compared with patients with normal BP.

Conclusions: WCH is associated with a greater risk for renal events in non-dialysis dependent Chinese patients with CKD.

Keywords: Ambulatory blood pressure monitoring; Chronic kidney disease; End-stage renal disease; White coat hypertension.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Proportion of BP patterns by different diagnostic criteria
Fig. 2
Fig. 2
Kaplan–Meier hazard curve for renal events by BP patterns

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