Blood pressure measurement in hemodialysis: The importance of the measurement technique

Abstract

Systemic arterial hypertension contributes to the high cardiovascular morbidity in hemodialysis (HD) patients, but the accuracy of blood pressure (BP) measurement in this population has not been well studied. To evaluate the agreement between BP measurement using the routine measurement technique (usual method) and the technique recommended by the VII Joint (standard method). This cross-sectional study enrolled 124 patients in a single center who had undergone dialysis for more than three months and were 18 years of age or older. The BP was verified at the start of dialysis by the nursing team (usual method) and by the researchers (standard method). The agreement between the systolic and diastolic BP (SBP and DBP) measurements was tested by the Bland-Altman analysis. A difference in BP measurement higher than ±5 mm Hg was considered clinically significant. The studied group had a mean age of 53.2 years. The average difference between routine and standard BP measurement was -6 mm Hg for SBP (limits of agreement: -40.1-28 mm Hg; P <0.001) and -5.6 mm Hg for DBP (limits of agreement: -33.1-21.8 mm Hg; P <0.001). A clinically significant difference in BP measured by both methods was observed in 69.4% of the patients for SBP and in 61.3% for DBP. The disagreement between the results of different BP measurement methods in HD patients was significant and the BP was underestimated using the usual BP method. BP measurement standardization should be encouraged to avoid errors in diagnosis and therapy.