Abstract: FR-PO1029
Comparability and Tolerability of Ambulatory and Home Blood Pressure Monitoring in Hemodialysis Patients
Session Information
- Hypertension and CVD: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
Authors
- Cohen, Jordana B., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
- Glidden, David V., University of California San Francisco, San Francisco, California, United States
- Linke, Lori, Kidney Research Institute, Seattle, Washington, United States
- Palad, Farshad, University of California San Francisco, San Francisco, California, United States
- Larson, Hanna Lo williams, University of Washington, Des Moines, Iowa, United States
- Mehrotra, Rajnish, University of Washington, Des Moines, Iowa, United States
- Townsend, Raymond R., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Bansal, Nisha, Kidney Research Institute, Seattle, Washington, United States
Background
44-hour (hr) ambulatory blood pressure monitoring (ABPM) in hemodialysis (HD) patients provides valuable prognostic information, but is often impractical in clinical practice. Home BP monitoring (HBPM) may be better suited for longitudinal BP management. However, limited evidence exists regarding the comparability and tolerability of ABPM and HBPM in this high risk population.
Methods
In a post-hoc analysis, we studied pre-randomization data from participants who agreed to 44-hr ABPM in a randomized controlled trial targeting a home vs. pre-HD systolic BP (SBP) <140 mmHg (NCT03459807).
Results
Of the 50 in-center HD patients enrolled, 31 (62%) agreed to ABPM. The mean age was 56 (SD 14) years, 13 (42%) were black. Mean pre-HD SBP was 146 (19) mmHg, ABPM SBP 140 (21) mmHg, daytime SBP 141 (20) mmHg, and nighttime SBP 134 (25) mmHg; 24 (77%) participants were non-dippers, including 7 (23%) reverse dippers. Home SBP was correlated with ABPM SBP (Figure); the strongest correlation was with daytime SBP in the initial 24-hrs post-HD (r=0.76, 95% CI 0.43-0.91). Using ABPM instead of HBPM, 2 participants were reclassified from controlled to masked hypertension (HTN), 1 from white coat to uncontrolled HTN, and 1 from masked to controlled HTN. Most patients described their ABPM experience as neutral (e.g. “No problem”); however, some expressed substantial discomfort (e.g. “the pressure was way too high and unbearable”). Participants described HBPM more positively (“It was fun and gave me knowledge of my own BP's”), with no reported discomfort.
Conclusion
Among HD patients, HBPM correlated with ABPM, particularly daytime post-HD ABPM readings. Given greater tolerability and feasibility for repeated measurements, HBPM seems to be a practical option for longitudinal monitoring and management of HTN among HD patients.
Correlation of HBPM, ABPM, and pre-HD BP
Funding
- NIDDK Support