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

Journal of Human Hypertension ARTICLE www.nature.com/jhh OPEN Relationship between medication class and ambulatory blood pressure profile in the chronic renal insufficiency cohort (CRIC) study Sachin V. Pasricha1, Debbie L. Cohen2, Rachel Shulman2, Rushelle Byfield 3 , Jordana B. Cohen 2,4 ✉ and CRIC Study Investigators* 1234567890();,: © The Author(s) 2026 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. Journal of Human Hypertension; https://doi.org/10.1038/s41371-026-01166-1 INTRODUCTION Hypertension is the leading cause of heart attacks, strokes, and cardiovascular mortality, accounting for one in five deaths globally, and the second biggest contributor to chronic kidney disease (CKD) progression [1]. Ambulatory blood pressure (BP) monitoring (ABPM) is the most accurate method to determine discordance between the office and out-of-office BP readings [2]. ABPM is particularly useful in diagnosing masked uncontrolled hypertension (MUCH; i.e., normal office BP with elevated out-ofoffice BP in individuals with treated hypertension) and white coat effect (i.e., elevated office BP with normal out-of-office BP in individuals with treated hypertension), which may be missed with office-based BP measurements alone in 20 and 30% of adults, respectively [3, 4]. ABPM is also the only mechanism to diagnose other high-risk BP profiles, including nocturnal hypertension, nocturnal non-dipping status, and short-term BP variability [5]. Patients with CKD have a high prevalence of MUCH, nocturnal hypertension, and nocturnal non-dipping status, and these ABPM profiles are strongly associated with an increased risk of cardiovascular events and CKD progression [6]. Most patients with CKD are also treated with antihypertensive medications. Antihypertensive medication classes have variable mechanisms and durations of action, implying that they may impact ABPM phenotype and nocturnal dipping status differently [7]. However, data is lacking on associations between ABPM profiles and different antihypertensive medication classes. The goal of our study was to evaluate whether individual antihypertensive medication classes are independently associated with specific ABPM profiles in patients with CKD using crosssectional data from the Chronic Renal Insufficiency Cohort (CRIC) Study. We aimed to generate hypotheses into whether longitudinal assessments of these relationships merit closer examination. METHODS Study population Our study population comprises participants from the CRIC Study who underwent ABPM and for whom medication data was available at the time of ABPM. The CRIC study enrolled patients aged 21–74 years old enrolled 1 Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada. 2Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 3Division of Pediatric Nephrology, Department of Pediatrics, Columbia University, New York, NY, USA. 4 Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. *A list of authors and their affiliations appears at the end of the paper. ✉email: Received: 21 January 2026 Revised: 23 April 2026 Accepted: 27 May 2026 S.V. Pasricha et al. 2 from 2003 to 2008 with an estimated glomerular filtration rate (eGFR) of 20–70 mL/min/1.73 m² who were followed longitudinally thereafter. The CRIC Study excluded individuals with glomerulonephritis, polycystic kidney disease, cirrhosis, class III/IV heart failure, HIV, active infection, active cancer, or pregnancy. Ethical approval was obtained from the institutional review boards at each participating site, and all CRIC Study participants provided written informed consent consistent with the principles outlined in the Declaration of Helsinki. Between 2008 and 2012, 1502 participants underwent ABPM as part of the study’s second phase. Importantly, the clinical characteristics of participants with ABPM data closely mirror those of the entire CRIC cohort, as demonstrated in previous publications [8]. Study design This is a cross-sectional study to assess the independent association between each antihypertensive medication class with ABPM profiles. Importantly, the statistical approach (multinomial logistic regression with penalized p-values) accounts for the fact that individuals may have simultaneously been taking multiple medications classes, and the associations studied thereby reflect independent associations between each specific medication class with ABPM profile, accounting for all other antihypertensive medication use [9]. Another possible approach to the issue account for simultaneous use of multiple medication classes would be to evaluate ABPM profiles in the mutually exclusive groups of patients based on combination regimens. However, statistical power would be limited in this approach given the plethora of combination regimens, so we chose the advantageous approach of a multinomial regression with penalized p-values. Exposure status Our primary exposure was antihypertensive medication class. Self-reported medica (...truncated)