open access

Vol 21, No 1 (2017)
ORIGINAL PAPERS
Published online: 2017-03-30
Get Citation

An intradialytic blood pressure assessment extended by two weeks predicts cardiovascular events with an accuracy comparable to that of home blood pressure measurements among hemodialysis patients

Renata Naruszewicz, Jacek Manitius
DOI: 10.5603/AH.2017.0006
·
Arterial Hypertension 2017;21(1):42-50.

open access

Vol 21, No 1 (2017)
ORIGINAL PAPERS
Published online: 2017-03-30

Abstract

Introduction. Pressure measurements obtained before and after hemodialysis (HD) are marked by their high variability and poor reliability, which undermine their ability to estimate cardiovascular events (CVs).

Objective. This study sought to determine whether more measurements performed over a longer period of time enable a more accurate evaluation of the CVs associated with arterial hypertension.

Material and methods. This study included 40 patients (23 men and 17 women) aged between 27 and 82 years with a mean age of 58.8 } 13.6 years who underwent chronic HD for 4 to 338 months. On days without HD, blood pressure home measurements (HMs) were recorded in the morning, afternoon and evening, and the results were obtained each day for 8 days. Furthermore, pressure measurements were recorded five times during 7 subsequent planned HD procedures: before HD, after HD and three times during HD. After 12 months, the number of CVs was determined with respect to the pressure measurement method. Results. The correlation coefficients between the HMs and HD with regard to systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were 0.85, 0.80, and 0.84, respectively (P < 0.001). The receiver operating curve (ROC) values for SBP were 137.8 mmHg for HM and 140.4 mmHg for HD. The sensitivity and specificity of the HMs for SBP were 0.667 and 0.727, respectively. CVs occurred in 66.7% of the patients with SBPs ≥ 137.8 mmHg. The sensitivity and specificity of the HD measurements of SBP were 0.611 and 0.818, respectively. CVs occurred in 73.3% of patients with SBPs ≥ 140.4 mmHg. Conclusions. Increasing the number of pressure measurements over a longer period of time in patients with HD likely improves the reliability of CV risk estimates.  

Abstract

Introduction. Pressure measurements obtained before and after hemodialysis (HD) are marked by their high variability and poor reliability, which undermine their ability to estimate cardiovascular events (CVs).

Objective. This study sought to determine whether more measurements performed over a longer period of time enable a more accurate evaluation of the CVs associated with arterial hypertension.

Material and methods. This study included 40 patients (23 men and 17 women) aged between 27 and 82 years with a mean age of 58.8 } 13.6 years who underwent chronic HD for 4 to 338 months. On days without HD, blood pressure home measurements (HMs) were recorded in the morning, afternoon and evening, and the results were obtained each day for 8 days. Furthermore, pressure measurements were recorded five times during 7 subsequent planned HD procedures: before HD, after HD and three times during HD. After 12 months, the number of CVs was determined with respect to the pressure measurement method. Results. The correlation coefficients between the HMs and HD with regard to systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were 0.85, 0.80, and 0.84, respectively (P < 0.001). The receiver operating curve (ROC) values for SBP were 137.8 mmHg for HM and 140.4 mmHg for HD. The sensitivity and specificity of the HMs for SBP were 0.667 and 0.727, respectively. CVs occurred in 66.7% of the patients with SBPs ≥ 137.8 mmHg. The sensitivity and specificity of the HD measurements of SBP were 0.611 and 0.818, respectively. CVs occurred in 73.3% of patients with SBPs ≥ 140.4 mmHg. Conclusions. Increasing the number of pressure measurements over a longer period of time in patients with HD likely improves the reliability of CV risk estimates.  

Get Citation

Keywords

cardiovascular events, hemodialysis, hemodialysis unit blood pressure measurements, home blood pressure measurements

About this article
Title

An intradialytic blood pressure assessment extended by two weeks predicts cardiovascular events with an accuracy comparable to that of home blood pressure measurements among hemodialysis patients

Journal

Arterial Hypertension

Issue

Vol 21, No 1 (2017)

Pages

42-50

Published online

2017-03-30

DOI

10.5603/AH.2017.0006

Bibliographic record

Arterial Hypertension 2017;21(1):42-50.

Keywords

cardiovascular events
hemodialysis
hemodialysis unit blood pressure measurements
home blood pressure measurements

Authors

Renata Naruszewicz
Jacek Manitius

References (16)
  1. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertension. 2013; 31(7): 1281–1357.
  2. Agarwal R, Sinha AD, Light RP, et al. Assessment of blood pressure in hemodialysis patients. Semin Dial. 2002; 15(5): 299–304.
  3. Agarwal R, Satyan S, Alborzi P, et al. Home blood pressure measurements for managing hypertension in hemodialysis patients. Am J Nephrol. 2009; 30(2): 126–134.
  4. Rossignol P, Cridlig J, Lehert P, et al. Visit-to-visit blood pressure variability is a strong predictor of cardiovascular events in hemodialysis: insights from FOSIDIAL. Hypertension. 2012; 60(2): 339–346.
  5. Agarwal R, Metiku T, Tegegne GG, et al. Diagnosing hypertension by intradialytic blood pressure recordings. Clin J Am Soc Nephrol. 2008; 3(5): 1364–1372.
  6. Agarwal R, Andersen MJ, Bishu K, et al. Home blood pressure monitoring improves the diagnosis of hypertension in hemodialysis patients. Kidney Int. 2006; 69(5): 900–906.
  7. Agarwal R, Lewis RR. Prediction of hypertension in chronic hemodialysis patients. Kidney Int. 2001; 60(5): 1982–1989.
  8. Agarwal R, Andersen MJ, Light RP. Location not quantity of blood pressure measurements predicts mortality in hemodialysis patients. Am J Nephrol. 2008; 28(2): 210–217.
  9. Vickers KS. Self-management education approach: engaging patients in creating a personal and relevant action plan (part 1) I keep telling patients what to do, so why don't they make progress? J Ren Nutr. 2012; 22(6): e51–e53.
  10. Agarwal R, Light RP. Median intradialytic blood pressure can track changes evoked by probing dry-weight. Clin J Am Soc Nephrol. 2010; 5(5): 897–904.
  11. Herzog CA, Asinger RW, Berger AK, et al. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2011; 80(6): 572–586.
  12. Alborzi P, Patel N, Agarwal R. Home blood pressures are of greater prognostic value than hemodialysis unit recordings. Clin J Am Soc Nephrol. 2007; 2(6): 1228–1234.
  13. Agarwal R. Systolic hypertension in hemodialysis patients. Semin Dial. 2003; 16(3): 208–213.
  14. Agarwal R, Andersen MJ, Agarwal R, et al. Prognostic importance of clinic and home blood pressure recordings in patients with chronic kidney disease. Kidney Int. 2006; 69(2): 406–411.
  15. Agarwal R, Brim NJ, Mahenthiran J, et al. Out-of-hemodialysis-unit blood pressure is a superior determinant of left ventricular hypertrophy. Hypertension. 2006; 47(1): 62–68.
  16. Raimann JG, Usvyat LA, Thijssen S, et al. Blood pressure stability in hemodialysis patients confers a survival advantage: results from a large retrospective cohort study. Kidney Int. 2012; 81(6): 548–558.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl