Abstract: SA-PO362
Telehealth-Assisted Home Blood Pressure (BP) Monitoring for In-Center Hemodialysis Patients
Session Information
- Hemodialysis and Frequent Dialysis: CV and Risk Prediction
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Obi, Yoshitsugu, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Zhang, Yunxi, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Chandra, Saurabh, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Tio, Maria Clarissa, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Wells, Catherine C., The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Dossabhoy, Neville R., The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Shafi, Tariq, The University of Mississippi Medical Center, Jackson, Mississippi, United States
Background
Home BP monitoring is essential to guide BP management for in-center hemodialysis (HD) patients but is exceedingly difficult to obtain in clinical practice. We designed a pragmatic feasibility study of a telehealth-assisted protocolized home BP monitoring program (TH-BP) at an academic dialysis clinic.
Methods
From 02/03/22 to 05/13/22, we referred 37 in-center HD patients to the TH-BP, of which 25 started monitoring. All patients were provided a BP monitor with an appropriately sized cuff and a connected iPad. We averaged pre-HD sitting systolic BP (preSBP) over 30 days before and after TH-BP initiation and compared them with home SBP from the TH-BP.
Results
Patients had a mean age of 50 years and had been on dialysis for 6.5 years; 52% were females. The median (IQR) number of antihypertensives was 2 (1, 3). During a median follow-up of 63 days, the mean±SD frequencies of TH-BP measurements (per day) were 1.1±0.4 and 1.4±0.9 on HD days and non-HD days, respectively. After TH-BP initiation, the 30-day preSBP was 146±15 mmHg (p=NS vs. the pre-TH-BP period; Table). Home SBP was significantly lower than preSBP by 12±18 mmHg (p=0.005; Figure). Similar results were observed with diastolic BP (Table). Baseline patient characteristics did not predict patient willingness to participate in the TH-BP or the differences between preSBP and home SBP.
Conclusion
This is the first report to demonstrate successful pragmatic implementation of home BP monitoring for in-center HD patients in a routine clinical setting. Our findings of lower home SBPs suggest that BP management based on dialysis BPs alone may overtreat.
Comparison of 30-day pre- and post-TH-BP pre-HD BP and home BP
| Systolic BP | Diastolic BP | ||||||
| Pre-HD | Home | P-value | Pre-HD | Home | P-value | ||
| Before TH-BP | 149±18 | - | - | 95±15 | - | - | |
| After TH-BP | 146±15 | 134±26 | 0.005 | 92±14 | 80±15 | <0.001 | |
Values are expressed as mean±SD, mmHg. P-values were calculated using the paired sample t-test.
Funding
- Other U.S. Government Support