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Objective: Studies using routine predialysis or postdialysis blood pressure (BP) recordings have provided considerably variable estimates of the prevalence and control of hypertension in the hemodialysis population. The aim of the present study was to investigate the epidemiology of hypertension in hemodialysis patients using the reference-standard technique of interdialytic ambulatory BP monitoring (ABPM). Design and method: A total of 70 hemodialysis patients underwent ABPM over an entire 44-hour interdialytic period (BP measurements at 20-minute intervals; Microlife WatchBP O3 device). Hypertension was defined as 44-hour ambulatory BP equal or higher than 130/80 mmHg or current use of antihypertensive medications. Results: The study included 70 patients (45 males and 25 females) with a mean age of 65.3±13.3 yeas and a median dialysis vintage of 15 months (range: 6, 33). Interdialytic ambulatory hypertension was prevalent in 90% of patients. Notably, isolated nocturnal hypertension was diagnosed in 27.1% of patients, whereas just 1.4% of patients had abnormal BP levels only during the daytime period. In all, 61 out of 63 hypertensives (96.8%) were receiving treatment with an average of 1.5±0.6 BP-lowering medications daily. Beta-blockers (75.4%) were the most commonly prescribed antihypertensive drug class, followed by dihydropyridine calcium-channel-blockers (42.6%) and renin-angiotensin-system inhibitors (8.2%). Lack of adequate ambulatory BP control was identified in 28.5% of hypertensives. Conclusions: This study shows that among patients on hemodialysis, the burden of interdialytic ambulatory hypertension is very high. The use of interdialytic ABPM enables the identification of isolated nocturnal hypertension, which is a very common BP phenotype in this patient population.
Leonidou et al. (Wed,) studied this question.