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Abstract: TH-PO715

Is It Worth Measuring Home Blood Pressure in Maintenance Hemodialysis Patients?

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Song, Sang Heon, Pusan National University Hospital, Busan, Korea (the Republic of)
  • Jeong, Hyeyun, Pusan National University Hospital, Busan, Korea (the Republic of)
  • Jeon, You Hyun, Pusan National University Hospital, Busan, Korea (the Republic of)
  • Han, Miyeun, Pusan National University Hospital, Busan, Korea (the Republic of)
  • Rhee, Harin, Pusan National University Hospital, Busan, Korea (the Republic of)
  • Seong, Eun Young, Pusan National University Hospital, Busan, Korea (the Republic of)
  • Kim, Il Young, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
  • Lee, Dong Won, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
  • Lee, Soo Bong, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
Background

The proper control of blood pressure(BP) is an important issue in hemodialysis patients and accurate BP measurement is mandatory. Although various methods of measurement of BP have been proposed, there is no standard method. The aims of this study are that office BP and home BP were compared based on ambulatory blood pressure monitoring (ABPM) in hemodialysis patients and propose the usefulness of home BP.

Methods

A total of 40 patients undergoing maintenance hemodialysis were enrolled for analysis of BP measurement from July 2018 to March 2019. Home BP was defined as the average of BP measured in a relaxed posture 5 minutes after the morning awaking and before sleeping. Office BP was predialysis BP and ABPM was undertaken 24 hours on non-dialysis days using Mobil-O-Graph® (NG, I.E.M. GmbH, Stolberg, Germany).

Results

The average BPs according to methods were as follows: home BP, 135.80 ± 17.29/ 73.99 ± 7.92 mmHg; office BP, 145.85 ± 17.44/ 73.70 ± 10.61mmHg; awake ABPM, 130.1 ± 20.78/ 76.48 ± 9.05mmHg. When compared to office BP with ABPM, 35% of the patients had sustained normotension, 42.5% of the patients had sustained hypertension, 22.5% of the patients had white-coat hypertension and masked hypertension cannot be observed. Based on ABPM, type of all patients was non-dipper, of which reverse-dippers were 32.5%. We analyzed the difference in systolic BP(SBP) in the home, office, and ABPM awake BP. SBP was the highest in office BP followed by home BP and ABPM in sequence. BP differences were as follows; ABPM-home SBP (-5.70 ± 14.51mmHg, P = 0.017), home-office SBP (-10.05 ± 12.19mmHg, P = 0.00), ABPM-office SBP (-15.75 ± 14.51mmHg, P = 0.00). 45% of patients had a 10% or more difference and 62.5% had a 5% or more difference in SBP between home and office. Interestingly, patients who had frequent intradialytic hypotension(IDH) tended to have a large difference in home-office SBP.

Conclusion

This study showed that the difference between home BP and ABPM was found to be approximately one third of the difference between office BP and ABPM. Because of the discomfort of ABPM measurements in patients with hemodialysis, home BP is necessary for proper BP management to prevent IDH. Conclusively, we propose that home BP could be a therapeutic target instead of ABPM in hemodialysis patients.