Ambulatory blood pressure monitoring identified uncontrolled hypertension in 39.3% of patients with glomerular diseases, a phenotype associated with the highest aldosterone-to-renin ratios.
Cohort (n=61)
No
ABPM and RAAS assessment in patients with glomerular diseases reveal distinct hypertension phenotypes with varying RAAS activity, highlighting the importance of ABPM for guiding antihypertensive therapy.
Objective: Pathogenetic mechanisms of arterial hypertension (HTN) in patients (pts) with chronic kidney disease (CKD), particularly in glomerular diseases (GD), demonstrate significant variability. The combination of renal dysfunction and variable renin-angiotensin-aldosterone system (RAAS) activation levels contributes to diverse HTN phenotypes, which may influence therapeutic strategy selection. However, RAAS activity patterns specific to ambulatory blood pressure monitoring (ABPM) based HTN phenotypes are poorly characterized in GD pts. Design and method: A cohort single center observational study included 61 pts (60% male, median age 55 years) with chronic glomerulonephritis. All pts were on combination antihypertensive therapy (AHT) prior to inclusion. Office BP was tripled measured on both arms at two visits. ABPM was performed according to standard protocol (ambulatory BP). Following BP phenotypes were identified (Table 1). RAAS assessment was performed in 44 pts: plasma aldosterone (ng/dL), plasma renin activity (PRA, ng/(mL·h)), and the aldosterone to renin ratio (ARR).Results: According ABPM, 24 pts (39.3%) had uncontrolled HTN, 23 (37.7%) had controlled HTN, 9 (14.8%) had masked HTN, and 5 (8.2%) had isolated nocturnal HTN. Only ABPM was able to reveal clinically significant HTN phenotypes in last two groups. Pts with lower eGFR more frequently had uncontrolled HTN. Statistically significant differences in RAAS activity were found across the HTN phenotypes (Table 2). Maximal PRA values occurred in controlled and nocturnal HTN groups. No intergroup differences in aldosterone levels were found (p = 0.183). However, ARR differed significantly, reaching its highest values in the uncontrolled HTN group. Conclusions: HTN phenotypes associated with the stage of CKD in GD pts. Uncontrolled and nocturnal HTN predominate from CKD stage 3b as GFR declines. Absence of ABPM leads to underestimation of HTN severity in 1/4 pts with GD. RAAS activity varies across HTN phenotypes. Aldosterone component predominates in uncontrolled HTN. In controlled HTN, elevated PRA is observed, likely reflecting the influence of AHT. In isolated nocturnal HTN, similar increase in PRA may indicate persistent RAAS activation. Obtained data confirm the importance of phenotyping HTN using ABPM and RAAS assessment in GD patients to guide timely initiation and optimization of effective AHT.
Komilova et al. (2026) conducted a cohort in Chronic glomerulonephritis (n=61). Hypertension phenotypes identified by ambulatory blood pressure monitoring was evaluated on RAAS activity (plasma aldosterone, plasma renin activity, and aldosterone to renin ratio). Ambulatory blood pressure monitoring identified uncontrolled hypertension in 39.3% of patients with glomerular diseases, a phenotype associated with the highest aldosterone-to-renin ratios.