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Kidney Week

Abstract: FR-PO266

Continuous Ambulatory Blood Pressure Monitoring: A Viable Option in CKD?

Session Information

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