C037: Reproducibility of ambulatory blood pressure in hemodialysis patients

• Published in: American journal of hypertension Vol. 13; no. S2; p. 223A
• Main Authors: Peixoto, A.J., Santos, S.F.F., Mendes, R.B., Crowley, S.T., Orias, M., Maldonado, R., Mansoor, G.A., White, W.B.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.04.2000
• Subjects: Ambulatory blood pressure; dipper; hemodialysis; renal failure; reproducibility
• ISSN: 0895-7061; 1879-1905; 1941-7225
• DOI: 10.1016/S0895-7061(00)00757-3

Better methods of managing hypertension in hemodialysis (HD) patients are needed. ABPM has been suggested to be a superior method to assess such patients. However, the reproducibility of ABPM compared to that of clinic pre and post-dialvsis BP has not been studied To address this question, we performed 48-hour interdialytic (ID) ABPM and pre and post-HD BP on 21 HD patients (age 54 ± 16 years, 14 males) on two different occasions 68 ± 34 days apart. Pre and post-HD BP was analyzed both as a single measure on the day of each ABPM and as a composite of 5 measures on the 5 HD sessions surrounding each ABPM. To qualify for the protocol, patients had to have the same prescribed dry weight and be on the same vasoactive drug regimen at both monitoring periods. The Table shows data for systolic BP (similar results were observed for diastolic BP). The standard deviation of the difference (SDD) for ABPM was smaller than for pre or post-dialysis clinic BPs, either as a single measure or as a composite, indicating better reproducibility of ABPM. However, the nocturnal BP decline (night:day ratio) showed limited reproducibility, with very wide limits of agreement, resulting in changes in dipping status (dipping defined as n:d ratio ≤0.90) in 30% of the patients. SBP Parameter Study 1 Study 2 Diff ± SDD Pre-HD 148 ± 25 145 ± 21 2.4 ± 24 Post-HD 142 ± 24 144 ± 20 −1.5 ± 17 Pre-HD 5-HD avg 142 ± 16 150 ± 16 −7.3 ± 15 Post-HD 5-HD avg 136 ± 17 144 ± 19 −6.8 ± 12 48-hour 140 ± 21 142 ± 19 −2.1 ± 11 n:d ratio ID day 1 0.95 ± 0.07 0.94 ± 0.08 0.02 ± 0.07 n:d ratio ID day 2 0.96 ± 0.10 0.96 ± 0.08 −0.004 ± 0.09 Conclusions: 1) ABPM has better reproducibility than clinic BP in HD patients; 2) the reproducibility of dipper and nondipper BP profile is poor. The factors responsible for this variability require further study.