Diagnosing Hypertension by Intradialytic Blood Pressure Recordings

Agarwal, Rajiv; Metiku, Tesfamariam; Tegegne, Getachew G.; Light, Robert P.; Bunaye, Zerihun; Bekele, Dagim M.; Kelley, Ken

doi:10.2215/cjn.01510308

Cited by 73 publications

(54 citation statements)

References 23 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The results of this study extend our earlier report that demonstrated excellent diagnostic test performance of single median BP recording in diagnosing hypertension (14). Given that our previous report conducted in a separate cohort was limited to cross-sectional analysis, it was unable to answer the question of whether median BP can also detect change in ambulatory BP over time.…”

Section: Discussioncontrasting

confidence: 60%

“…But the BPs so recorded are usually ignored when making a diagnosis of hypertension. We have previously shown that among long-term hemodialysis patients, median intradialytic BP can diagnose hypertension (14). The diagnostic test performance was excellent, but the study was cross-sectional in nature.…”

mentioning

confidence: 91%

“…Our earlier study had shown the median BP obtained was sufficient to diagnose hypertension even when made on one dialysis occasion (14). However, most investigators have taken 2-week averaged predialysis or postdialysis BP measurements when they have compared these to ambulatory recordings (15,16).…”

mentioning

confidence: 99%

See 2 more Smart Citations

Median Intradialytic Blood Pressure Can Track Changes Evoked by Probing Dry-Weight

Agarwal

Light²

2010

Clinical Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

Background: Median BP obtained over a single dialysis treatment can diagnose hypertension among hemodialysis patients. Whether median BP is as useful to track change in BP is unknown.Design, setting, participants, & measurements: Among patients participating in the dry-weight reduction in hypertensive hemodialysis patients (DRIP) trial, interdialytic ambulatory BP was recorded at baseline, 4 weeks, and 8 weeks. The mean interdialytic ambulatory BP was compared to the following recordings: predialysis on one dialysis treatment (Pre1), predialysis averaged over 2 weeks of dialysis treatment (Pre6), postdialysis on one dialysis treatment (Post1), postdialysis averaged over 2 weeks of dialysis treatment (Post6), and median intradialytic BP over one treatment.Results: Pre1 was unable to detect change in ambulatory BP. Although Pre6 was able to detect change, it overestimated the ambulatory BP. On average, the magnitude of reduction in Post1 in response to probing dry-weight was nearly twice that obtained by ambulatory BP monitoring. Even Post6 overestimated the magnitude of reduction in BP at 8 weeks. Median systolic BP was responsive to probing dry-weight and neither overestimated nor underestimated the interdialytic ambulatory systolic BP at baseline or over time. However, the SD of the differences between median systolic BP and interdialytic ambulatory systolic BP varied from 16 to 20 mmHg.Conclusions: Median intradialytic BP recordings can detect change in ambulatory BP evoked by reduction in dry-weight at the population level. Because of wide agreement limits between intradialytic and interdialytic BP, the individual prediction of ambulatory BP from median intradialytic BP can be misleading.

show abstract

Section: Discussioncontrasting

confidence: 60%

mentioning

confidence: 91%

See 1 more Smart Citation

Median Intradialytic Blood Pressure Can Track Changes Evoked by Probing Dry-Weight

Agarwal

Light²

2010

Clinical Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Indeed, if anything, the casual practice of attempting to control BPs with ultrafiltration is clearly superior to changing medications based on predialysis and postdialysis BP. 3 It is unfortunate that nephrologists in current North American practice are rarely present on site during outpatient renal dialysis, unlike their European or Japanese counterparts. The relative lack of "presence" of a nephrologist, along with limited reimbursement and scarcity of trained nursing staff may have contributed to the slow implementation of ABPM among dialysis patients in North America, despite its proven efficacy 2,4 and excellent acceptance of the procedure.…”

mentioning

confidence: 99%

On Poor Agreement Between Dialysis Unit and Ambulatory Blood Pressures

Fülöp

Zsom

2015

J of Clinical Hypertension

View full text Add to dashboard Cite

“…Hence, conclusions should be validated by additional well-designed studies. In fact, in a representative study by Agarwal and colleagues, 1 the authors concluded that intradialytic BPs should also be taken into consideration together with predialysis and postdialysis BPs for diagnosing hypertension.…”

mentioning

confidence: 99%

Reply to: On Poor Agreement Between Dialysis Unit and Ambulatory Blood Pressures

Liu

Dai

Yang

2015

J of Clinical Hypertension

View full text Add to dashboard Cite

We do appreciate the interest from Dr F€ ul€ op and Dr Zsom regarding our published work. They raised a concern about the correlation between dialysis unit blood pressure (BP) measurements and ambulatory BP values. To address this issue, we carried out an analysis and found that in our study both postdialysis (P<.001) and predialysis (P<.001) systolic BPs were independently correlated with ambulatory systolic BP. The conclusion was similar for diastolic BP (P<.001 for postdialysis diastolic BP, P=.025 for predialysis diastolic BP).Although disparities exist in the results between Dr F€ ul€ op and Dr Zsom's and ours, both studies had a similar conclusion that postdialysis BP has a more pronounced correlation with ambulatory BP. However, caution should be taken when interpreting such data because of the disparities in many factors such as the method for obtaining dialysis unit BP and the size of the population. Hence, conclusions should be validated by additional well-designed studies. In fact, in a representative study by Agarwal and colleagues, 1 the authors concluded that intradialytic BPs should also be taken into consideration together with predialysis and postdialysis BPs for diagnosing hypertension.While predialysis and/or postdialysis BPs are tightly correlated with ambulatory BP, it is worthy to note that the association does not equal agreement. There is no doubt that the agreement between dialysis unit BP and ambulatory BP is poor. 2 Given the inconvenience and cost of ambulatory BP monitoring, home BP has been shown to be a reliable and feasible option for BP management in dialysis patients. 3

show abstract

Diagnosing Hypertension by Intradialytic Blood Pressure Recordings

Cited by 73 publications

References 23 publications

Median Intradialytic Blood Pressure Can Track Changes Evoked by Probing Dry-Weight

Median Intradialytic Blood Pressure Can Track Changes Evoked by Probing Dry-Weight

On Poor Agreement Between Dialysis Unit and Ambulatory Blood Pressures

Reply to: On Poor Agreement Between Dialysis Unit and Ambulatory Blood Pressures

Contact Info

Product

Resources

About