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Abstract: FR-PO1030

The Accuracy of Clinic and Home Blood Pressure Recordings in Diagnosing Hypertension Among Patients on Peritoneal Dialysis

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Liakopoulos, Vassilios, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • Vaios, Vasileios, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • Georgianos, Panagiotis I., AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • Vareta, Georgia, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • Dounousi, Evangelia, University Hospital of Ioannina, Ioannina, Greece
  • Papagianni, Aikaterini A., Hipokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • Zebekakis, Pantelis, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
Background

Earlier studies testing the diagnostic accuracy of blood pressure (BP) measurement techniques among patients on peritoneal dialysis (PD) have shown that home BP recordings overestimate daytime ambulatory BP and are inferior to standardized automated clinic BP measurements in diagnosing hypertension. The aim of this study is to elucidate this paradoxical observation that contradicts evidence from the general hypertensive population and may be attributable to methodological limitations of earlier studies.

Methods

In a cohort of 81 stable PD patients with unmodified antihypertensive therapy or dialysis regimen for at least 2 weeks prior to study enrollment, BP was recorded using 3 different methodologies: (i) triplicate automated clinic BP recordings after a 5-min seated rest with the self-inflating monitor HEM 705 CP (Omron Healthcare); (ii) 1-week averaged morning and evening home BP recordings taken by the patients themselves with validated automated BP monitors; (iii) 24-hour ambulatory BP monitoring with the oscillometric device Mobil-O-Graph (IEM, Germany).

Results

In Bland-Altman analysis, clinic systolic BP (SBP) overestimated daytime ambulatory SBP by 5.02 mmHg with 95% limits of agreement ranging from -17.92 to 27.96 mmHg. Similarly, home SBP overestimated daytime ambulatory SBP by 4.23 mmHg, again with wide 95% limits of agreement (-16.05 to 24.51 mmHg).The area under the curve of receiver operating characteristic (ROC) curve for clinic and home SBP to detect a daytime ambulatory SBP ≥135 mmHg was 0.859 (95% CI: 0.776-0.941) and 0.895 (95% CI: 0.815-0.976), respectively. Home SBP of ≥138.5 mmHg had the best combination of sensitivity (80.6%) and specificity (84%) in diagnosing ambulatory systolic hypertension.

Conclusion

1-week averaged home BP recordings are at least similar with a standardized BP measurement at clinic in detecting ambulatory hypertension among patients on PD.