Relationship between medication class and ambulatory blood pressure profile in the chronic renal insufficiency cohort (CRIC) study

Patients with chronic kidney disease (CKD) are at increased risk for masked and nocturnal hypertension, conditions best identified through ambulatory blood pressure (BP) monitoring (ABPM) and associated with adverse cardiovascular outcomes. We evaluated associations between antihypertensive medication classes and ABPM profiles by conducting a cross-sectional analysis of participants from the Chronic Renal Insufficiency Cohort (CRIC) with ABPM data. Antihypertensive medications were categorized as renin-angiotensin system inhibitors (RASis), beta-blockers, calcium channel blockers (CCBs), and thiazide/loop diuretics. We used multinomial logistic regression to evaluate the independent association between each medication class (accounting for simultaneous use of multiple classes) and ABPM phenotype: controlled hypertension, white coat effect, sustained hypertension, and masked uncontrolled hypertension (MUCH). Secondary outcomes included nocturnal hypertension, nocturnal non-dipping, and BP variability. Analyses were Bonferroni-corrected for multiple comparisons. Among 1499 eligible participants, 66% used RASis, 52% beta-blockers, 43% CCBs, and 50% thiazide/loop diuretics. RASi use was associated with lower odds of sustained hypertension (OR 0.60, 95% CI 0.42 to 0.84), while beta-blocker use was positively associated with MUCH (OR 1.48, 95% CI: 1.12 to 1.96). For secondary outcomes, RASi use was associated with lower odds of nocturnal hypertension (OR 0.71, 95% CI: 0.55 to 0.91), whereas beta-blocker and CCB use were both associated with nocturnal hypertension (OR for beta-blockers 1.33, 95% CI 1.04 to 1.70; OR for CCBs 1.36, 95% CI 1.07 to 1.73). Overall, we identified several associations between specific antihypertensive classes and abnormal ABPM profiles. Longitudinal studies are needed to evaluate reproducibility and potential mechanisms of these findings.