Abstract: FR-PO266
Continuous Ambulatory Blood Pressure Monitoring: A Viable Option in CKD?
Session Information
- CKD: Epidemiology and Risk Factors
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Canales, Muna T., Malcom Randall VAMC, Gainesvile, Florida, United States
- Bozorgmehri, Shahab, University of Florida, Gainesville, Florida, United States
- Berry, Richard, Malcom-Randall VAMC, Gainesville, Florida, United States
- Beyth, Rebecca, Dept of VA & Univ. of Florida, Gainesville, Florida, United States
Background
Traditional cuff-based ambulatory blood pressure monitoring (ABPM) is cumbersome and fragments sleep. Continuous ABPM utilizes a simple pulse oximeter and 2-lead electrocardiogram to calculate blood pressure beat to beat from pulse transit time(PTT). While continuous ABPM overcomes the challenges of traditional ABPM, its validity in CKD—a population with a high burden of vascular disease—is unclear.
Methods
Two separate cohorts (20 Veterans and 20 University hospital-based) were enrolled for this study. Inclusion criteria were: age 18-89, MDRD eGFR 15-44, not on dialysis or transplant. Participants underwent simultaneous 24 hour cuff-ABPM (Spacelabs) and PTT-ABPM (Somnomedics). We determined the correlation between 24-hour blood pressure for cuff and PTT-ABPM. We used McNemar’s test for correlated proportions to assess the degree of concordance between cuff and PTT-ABPM to determine dipping status (p<0.05 suggests lack of concordance).
Results
Among Veterans, mean age(SD) was 76(9) years, 95% male, mean BMI 31(5) kg/m2, 95% hypertensive, 60% diabetic and 5% with peripheral vascular disease(PVD). At the University site, mean age(SD) was 67(11) years, 50% male, mean BMI 31(8) kg/m2, 85% were hypertensive and 35% diabetic. None had PVD. The table below shows, by method, the average number of blood pressure readings, mean 24-hour blood pressure and the correlation between cuff and PTT-ABPM. Among Veterans, there was concordance with systolic dipping(McNemar’s p 0.10) but not diastolic dipping(p=0.02). Among University participants, concordance was not observed for diastolic dipping(p=0.02) and the test could not be performed for systolic dipping as none of the PTT-ABPM had dipping though 8 were dippers by cuff-ABPM.
Conclusion
Among Veterans with CKD, PTT-ABPM correlates reliably with cuff ABPM for overall and systolic blood pressure as well as systolic dipping status. Among University CKD patients, PTT-ABPM does not correlate well with cuff-ABPM. Additional validation studies with larger sample sizes are required to confirm our findings.
Funding
- Other NIH Support