Abstract: FR-PO564

Individualizing Hypertensive Treatment in Dialysis Population: Thinking beyond Intradialytic Blood Pressure Readings

Session Information

Category: Hypertension

  • 1104 Hypertension: Clinical and Translational - Salt and Hypertension

Authors

  • Jasani, Rachana H, Apex Kidney Foundation , Mumbai, Maharashtra, India
  • Dedhia, Paras, Apex Kidney Foundation , Mumbai, Maharashtra, India
  • Billa, Viswanath, Apex Kidney Foundation , Mumbai, Maharashtra, India
  • BICHU, SHRIRANG, Apex Kidney Foundation , Mumbai, Maharashtra, India
  • Kumar, Rajesh B., Apex Kidney Foundation , Mumbai, Maharashtra, India
Background

Majority of hypertension treatment decisions are made based on dialysis unit BP readings. Out of dialysis unit blood pressure readings are shown to be associated with left ventricular hypertrophy and mortality.

Methods

Ambulatory BP monitoring (ABPM) performed for 44 hours in between 2 dialysis sessions. ABPM BP recorded every 20 min during the day (7am to 11pm) and every 30 min during the night (11pm to 7am) in non-fistula arm. Hourly means were averaged to obtain interdialytic systolic and diastolic blood pressure readings over 44 hours. Less than 70% readings were excluded from the study. Along with BP means, Percent Time Elevation (PTE-duration of day spent in high blood pressure state), dipping status at night, morning surge (the difference in systolic blood pressure during the first two hours after awakening and the lowest level recorded during night) and Pulse Pressure (PP) were assessed from ABPM data.

Results

Of 40 subjects, 68% were males. Average age was 54.5± 12.3 years. 45% had diabetes, 98% had hypertension and 20% had IHD. 80% subjects had >40% PTE. In terms of dipping status, 7.5% had normal dipping (10-20% drop in SBP at night), 67.5% were non-dippers (<10% drop in SBP at night) and 25% had reverse dipping status (nocturnal BP higher than diurnal BP). In our study, 10% had > 20% morning surge. We observed 27.5% had PP between 40 – 60 mm Hg, 45% had PP between 60 -80 mm Hg, 22.5% had PP between 80 – 100 mm Hg.

Conclusion

Blood pressure readings obtained from ABPM helps to individualize hypertension management in relation to timing and selection of anti-hypertensive agent. Also, it helps to provide a targeted approach in treating dialysis patients with diurnal variations in BP on dialysis and non-dialysis days.