Automated in-office BpTRU measurement was more accurate than home BP monitoring, which significantly overestimated daytime systolic BP by 14.2 mmHg (95% CI 4.3-24.1; P=0.008) in PD patients.
Cross-Sectional (n=17)
No
Which blood pressure measurement method (office, home, or BpTRU) best correlates with daytime ambulatory blood pressure in peritoneal dialysis patients?
In peritoneal dialysis patients, automated BpTRU and office blood pressure measurements are more accurate than home blood pressure monitoring when compared to daytime ambulatory blood pressure.
Mean Difference: 14.2 (95% CI 4.3–24.1)
p-value: p=0.008
BACKGROUND: The optimal approach to monitoring blood pressure (BP) in the peritoneal dialysis (PD) population is unclear. Ambulatory BP monitoring reliably predicts prognosis, but can be inconvenient. The accuracy of home BP monitoring in this population is unproven. The automated BpTRU device (BpTRU Medical Devices, Coquitlam, BC, Canada), which provides an average of up to 6 successive in-office BP measurements, has not been studied in this patient group. METHODS: We studied 17 patients (average age: 54 ± 12 years; 12 men, 5 women; 94% on automated PD) attending a single center. All patients underwent office, home, BpTRU, and ambulatory BP measurement. The reference standard for analysis was daytime ambulatory BP. Correlation between the referent method and each comparator method was determined (Pearson correlation coefficient), and Bland-Altman scatter plots depicting the differences in the BP measurements were constructed. RESULTS: Mean office BP (126.4 ± 16.9/78.8 ± 11.6 mmHg) and BpTRU BP (123.8 ± 13.7/80.7 ± 11.1 mmHg) closely approximated mean daytime ambulatory BP (129.3 ± 14.8/78.2 ± 7.9 mmHg). Mean home BP (143.8 ± 15.0/89.9 ± 28.1 mmHg) significantly overestimated mean daytime systolic BP by 14.2 mmHg (95% confidence interval: 4.3 mmHg to 24.1 mmHg; p = 0.008). Bland-Altman plots demonstrated poorest agreement between home BP and daytime ambulatory BP. No patient had "white-coat hypertension," and only 1 patient had false-resistant hypertension. Most patients showed abnormal nocturnal dipping patterns (non-dipping: n = 11; reverse-dipping: n = 5; normal dipping: n = 1). CONCLUSIONS: We report a novel finding that BP measurement using the BpTRU device is more accurate than home BP measurement in a PD population. Potential explanations for this observation include poor home BP measurement technique, use of poorly validated home BP measurement devices, or a reduced prevalence of white-coat effect among PD patients. Our study also confirms that, in the PD population, BP measurements vary considerably with patient location, time of day, and measurement technique.
O’Shaughnessy et al. (Mon,) conducted a cross-sectional in Peritoneal dialysis (n=17). BpTRU and home blood pressure measurement vs. Daytime ambulatory blood pressure monitoring was evaluated on Difference in systolic BP compared to daytime ambulatory BP (MD 14.2, 95% CI 4.3-24.1, p=0.008). Automated in-office BpTRU measurement was more accurate than home BP monitoring, which significantly overestimated daytime systolic BP by 14.2 mmHg (95% CI 4.3-24.1; P=0.008) in PD patients.
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