Home blood pressure recordings were stronger predictors of mortality than dialysis unit recordings, with a 1-SD increase in home systolic BP increasing the risk of death by 1.35 (95% CI 0.99-1.84).
Cohort (n=150)
Yes
Do home blood pressure recordings predict all-cause and cardiovascular mortality better than dialysis unit recordings in hemodialysis patients?
Home blood pressure recordings are stronger predictors of mortality than dialysis unit recordings in patients on chronic hemodialysis.
Effect estimate: HR 1.35 (95% CI 0.99-1.84)
BACKGROUND AND OBJECTIVES: Although ambulatory BP recordings are found to be superior to dialysis unit recordings in predicting outcomes, ambulatory BP are difficult to obtain in the day-to-day treatment of hemodialysis patients. Home BP agree well with ambulatory BP, but the prognostic significance of home BP recordings is unknown in hemodialysis patients. This study ascertained the role of home BP in predicting all-cause and cardiovascular mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A prospective cohort study was conducted in 150 patients who were on chronic hemodialysis dialyzing at four university-affiliated units. BP was self-measured at home for 1 wk, for an interdialytic interval by ambulatory recording, and by "routine" and standardized methods in the dialysis unit for 2 wk. Patients were followed for a median of 24 mo to assess the end points of all-cause and cardiovascular mortality. RESULTS: Cardiovascular death occurred in 26 (17%) patients and death in 46 (31%) patients. A 1-SD increase in systolic BP increased the risk for death by 1.35 (95% CI 0.99 to 1.84) and in diastolic BP by 1.40 (95% CI 1.03 to 1.93) for home BP and between 0.97 to 1.19 (P > 0.20) for all-cause mortality for dialysis unit BP recording. A dose-response relationship between increasing quartiles of home BP and all-cause mortality and cardiovascular mortality was seen. CONCLUSIONS: Self-measured systolic BP of 125 to 145 mmHg and of 115 to 125 mmHg by ambulatory BP is associated with the best prognosis in hemodialysis patients.
Alborzi et al. (Wed,) conducted a cohort in Chronic hemodialysis (n=150). Home blood pressure recording vs. Dialysis unit blood pressure recording was evaluated on All-cause and cardiovascular mortality (HR 1.35, 95% CI 0.99-1.84). Home blood pressure recordings were stronger predictors of mortality than dialysis unit recordings, with a 1-SD increase in home systolic BP increasing the risk of death by 1.35 (95% CI 0.99-1.84).