COMPARISON OF AUTOMATED OFFICE BLOOD PRESSURE MEASURMENT AND 44-HOUR AMBULATORY BLOOD PRESSURE MONITORING IN HEMODIALYSIS

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Objective: Arterial hypertension occurs in nearly 82-89% of patients who undergo dialysis due to renal failure. In this group of patients, hypertension is satisfactorily controlled in only 30% of patients. The lack of satisfactory blood pressure control is associated with very high cardiovascular morbidity and mortality. 44-hour ambulatory blood pressure monitoring (ABPM) remains a gold standard in this group. In the recent years automated office blood pressure monitoring (AOBP) has been proposed to increase the accuracy of office blood pressure (OBP) readings. This study aimed to compare 44-hour ABPM with postdialytic and predialytic AOBPM in HD patients on stable hemodialysis prescription. Design and method: We examined 58 patients (mean age 65.7 ± 13.7, 63.8% male, 44.8% permcath), who were undergoing a middle of a week dialyses in our HD-center. In each patient AOBPM measurement was be performed after dialysis and then for 44 hours (interdialysis period) an ABPM monitor was worn. After the ABPM was completed, the pressure was measured again by the AOBPM method. Results: We found significant statistical difference in AOBPM measurement values post and pre dialyses. Systolic blood pressure (SBP) and diastolic blood pressure post dialyses measured by AOBPM were significantly higher than mean SBP and DBP in ABPM (SBP p=0.008, DBP p=0.004). Similarly, SBP and DBP in AOBOM post dialyses were significantly higher than mean SBP and DBP in ABPM (SBP p-value = 0.0005, DBP p-value = 0.004).Conclusions: Automated office blood pressure measurements (AOBPM) performed both before and after hemodialysis demonstrate statistically significant differences when compared with mean values obtained from 44-hour ABPM, with a consistent tendency to overestimate both systolic and diastolic blood pressure. Therefore, AOBPM should not be considered an optimal method for blood pressure assessment in hemodialysis patients, with ABPM remaining the reference standard.

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