What question did this study set out to answer?

To assess discrepancies between pre-dialysis office blood pressure and 24-hour ambulatory blood pressure measurements compared against the gold-standard 48-hour ambulatory blood pressure measurement in haemodialysis patients.

March 3, 2009Nephrology

Blood pressure assessment in haemodialysis patients: Comparison between pre‐dialysis blood pressure and ambulatory blood pressure measurement

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Why the study?

Does 24-hour ABPM or pre-dialysis OBP accurately reflect 48-hour ABPM for diagnosing hypertension in haemodialysis patients?

Key Points

To assess discrepancies between pre-dialysis office blood pressure and 24-hour ambulatory blood pressure measurements compared against the gold-standard 48-hour ambulatory blood pressure measurement in haemodialysis patients.
Evaluated 163 haemodialysis patients using continuous 48-hour ambulatory blood pressure measurement (ABPM), separated into 24-hour dialysis (HD) and inter-dialysis (iHD) intervals.
Calculated office blood pressure (OBP) as the average of 12 consecutive pre-dialysis sessions to compare against ABPM periods.
Office BP significantly overestimated systolic and diastolic BP, showing lower diagnostic sensitivity (72.6%) and specificity (83.3%) for hypertension compared to 24-hour iHD ABPM (sensitivity 98.4%, specificity 90.0%) and 24-hour HD ABPM (sensitivity 90.3%, specificity 96.6%).
Hypertension was diagnosed in 80.5% of patients using 48-hour ABPM versus 61.7% using pre-dialysis OBP (chi-square = 13.28, P < 0.001).
Correlation with 48-hour ABPM was strong for 24-hour ABPM (r^2 = 0.95, P < 0.001), but weak for OBP (r^2 = 0.40 for SBP, r^2 = 0.12 for DBP, both P < 0.01).

Structured PICO

Does 24-hour ABPM or pre-dialysis OBP accurately reflect 48-hour ABPM for diagnosing hypertension in haemodialysis patients?

Population

163 haemodialysis (HD) patients

Intervention

Pre-dialysis office blood pressure (OBP) measurement and 24-hour ambulatory blood pressure measurement (ABPM) on dialysis (HD) day and inter-dialysis (iHD) day

Comparator

48-hour ambulatory blood pressure measurement (ABPM) (considered the gold standard)

Outcome

Differences in systolic and diastolic blood pressure levels and diagnostic accuracy (sensitivity and specificity) for detecting hypertensionsurrogate

24-hour ambulatory blood pressure monitoring is a more accurate alternative to pre-dialysis office blood pressure for diagnosing hypertension in haemodialysis patients.

Discussion

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Implication

May warrant caution relying on pre-dialysis OBP alone in HD; leaves open outcome trials with ABPM.

Cite This Study

Fagugli et al. (2009) studied this question.

synapsesocial.com/papers/6a914c7e80800acc7233fb57 https://doi.org/10.1111/j.1440-1797.2009.01090.x

Topics

Hypertension management

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Blood pressure assessment in haemodialysis patients: Comparison between pre‐dialysis blood pressure and ambulatory blood pressure measurement

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Blood pressure assessment in haemodialysis patients: Comparison between pre‐dialysis blood pressure and ambulatory blood pressure measurement

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider