Home Blood Pressure Measurements for Managing Hypertension in Hemodialysis Patients

Agarwal, Rajiv; Satyan, Sangeetha; Alborzi, Pooneh; Light, Robert P.; Tegegne, Getachew G.; Mazengia, Helmneh S.; Yigazu, Paulos M.

doi:10.1159/000206698

Cited by 66 publications

(49 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…(2) Because this BP is readily available, epidemiologists may want to reassess the prognostic significance of high or low BP and its change over time on cardiovascular events and mortality; this may better clarify the prognostic significance of median intradialytic BP. (3) For clinicians, our study shows that if home BP monitoring is not available or possible, then the consideration of intradialytic BP recordings may improve the diagnosis and management of hypertension among hemodialysis patients (29).…”

Section: Discussionmentioning

confidence: 90%

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: Discussionmentioning

confidence: 90%

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

“…Amerika Birleşik Devletlerinde kronik böbrek yetmezliği nedeniyle hemodiyaliz tedavisi gören hastaların %72'sinde hipertansiyon görüldüğü ve hastaların %58'inin antihipertansif tedavi almalarına karşın, hipertansiyonun kontrol altında olmadığı saptanmıştır (1,2). Ülkemizde ise hemodiyaliz tedavisi gören hastaların %44,4'ü hipertansif olup, bu hastaların yaklaşık yarısının kan basınçlarının kontrol altında olmadığı ve hastaların %53,5'inin kardiyovasküler komplikasyonlar nedeniyle öldüğü bildirilmektedir (3).…”

Section: Introductionunclassified

“…Agarwal ve ark. (2009) kan basıncı kontrolünün sağlanmasında hipertansif hemodiyaliz hastaların evlerinde kan basıncı ölçüp takip etmelerinin başarıyı artırdığını bulmuşlardır (2).…”

Section: Introductionunclassified

Hemodiyaliz Hastalarının Hipertansiyon Yönetimine İlişkin Evde Yaptıkları Uygulamalar

Gökdoğan¹,

Kes²,

Turgay³

et al. 2017

Turk Neph Dial Transpl

View full text Add to dashboard Cite

Öz aMaÇ: Bu araştırmanın amacı, hemodiyaliz hastalarının hipertansiyon yönetimine ilişkin evde yaptıkları uygulamaları belirlemektir. GEREÇ ve YÖnTEMLER:Tanımlayıcı nitelikte yapılan çalışmanın evrenini Karabük ili sınırlarında bulunan iki devlet, bir özel ve bir eğitim araştırma hastanesi hemodiyaliz merkezinde tedavi gören toplam 279 hasta oluşturdu. Örneklemde ise 18 yaş üstü, hipertansiyonu olan, iletişim kurabilen, klinik durumu stabil olan, mental ve psikiyatrik rahatsızlığı olmayan, araştırmaya gönüllü olarak katılmayı kabul eden 120 hasta yer aldı.BuLGuLAR: Araştırmaya katılan hastaların %59,2'sinin evde kan basınçlarını düzenli olarak ölçmedikleri; %44,6'ünün ilaçlarını düzenli olarak kullanmadıkları, ilaçlarının adını ve dozunu bilmedikleri (sırasıyla % 60,7, % 64,3); %73,2'sinin hekim bilgisi dışında ilaçlarını kullanmayı bıraktıkları;%85'inin yemeklerinde tuz kullandığı ve %46,7'sinin sıvı kısıtlamasına uyum göstermediği saptandı.SOnuÇ: Hemodiyaliz hastalarının bireysel özelliklerine göre evde hipertansiyon yönetimine ilişkin düzenli eğitim, izlem ve danışmanlık yapılarak öz yönetimlerinin güçlendirilmesinde hemşirelik bakım yaklaşımının etkilerinin çalışmalarla ortaya konması önemli görünmektedir.AnAhTAR SÖzcükLER: Hipertansiyon, Hemodiyaliz, Hemşirelik, Evde bakım ABSTRAcTOBJEcTIVE: This study aimed to determine home application by hemodialysis patients for hypertension management. MATERIAL and METhOdS:The population of the descriptive study included a total of 279 patients who were treated at the hemodialysis centers of two state hospitals, one private hospital and one training and research hospital situated within Karabük province. A total of 120 patients who were over 18 years of age, had hypertension, could communicate, and whose clinic state were stable, who did not have any mental and psychiatric disorder and who accepted to participate in the research voluntarily were included in the sample. RESuLTS:It was determined that 59.2% of the patients who participated in the study did not measure their blood pressures at home regularly; 44.6% did not take their medication regularly and did not know the name and dosages of their medication (60.7% and 64.3% respectively); 73.2% had stopped taking medication without the physician's knowledge; 85% used salt in meals; and 70.8% and 46.7% respectively did not comply with the liquid limitation. cOncLuSIOn:It is important to reveal the effects of a nursing care approach for supporting hypertension self-management at home of our patients based on their individual characteristics through studies focusing on regular training, monitoring and providing consultancy services.

show abstract

“…In the long-term, however, repeated ambulatory BP monitoring can be inconvenient for the patient and demanding on hospital resources. Home BP measurement, another out-of-office approach to BP monitoring, is a valid alternative to ambulatory BP monitoring in patients with and without chronic kidney disease, including those receiving maintenance hemodialysis (7)(8)(9). However, for as yet unexplained reasons, the home technique appears be less accurate than standard office BP measurement in the PD population (3) intervals in the absence of a health professional, can negate "white-coat" effect and improve the accuracy of in-office BP measurement in patients with and without chronic kidney disease (10,11).…”

mentioning

confidence: 99%

Blood Pressure Measurement in Peritoneal Dialysis: Which Method is Best?

et al. 2013

View full text Add to dashboard Cite

♦ Background: The optimal approach to monitoring blood pressure (BP) in the peritoneal dialysis (PD) population is unclear. Ambulatory BP monitoring reliably predicts prognosis, but can be inconvenient. The accuracy of home BP monitoring in this population is unproven. The automated BpTRU device (BpTRU Medical Devices, Coquitlam, BC, Canada), which provides an average of up to 6 successive in-office BP measurements, has not been studied in this patient group. ♦ Methods: We studied 17 patients (average age: 54 ± 12 years; 12 men, 5 women; 94% on automated PD) attending a single center. All patients underwent office, home, BpTRU, and ambulatory BP measurement. The reference standard for analysis was daytime ambulatory BP. Correlation between the referent method and each comparator method was determined (Pearson correlation coefficient), and Bland-Altman scatter plots depicting the differences in the BP measurements were constructed. ♦ Results: Mean office BP (126.4 ± 16.9/78.8 ± 11.6 mmHg) and BpTRU BP (123.8 ± 13.7/80.7 ± 11.1 mmHg) closely approximated mean daytime ambulatory BP (129.3 ± 14.8/78.2 ± 7.9 mmHg). Mean home BP (143.8 ± 15.0/89.9 ± 28.1 mmHg) significantly overestimated mean daytime systolic BP by 14.2 mmHg (95% confidence interval: 4.3 mmHg to 24.1 mmHg; p = 0.008). Bland-Altman plots demonstrated poorest agreement between home BP and daytime ambulatory BP. No patient had "white-coat hypertension," and only 1 patient had false-resistant hypertension. Most patients showed abnormal nocturnal dipping patterns (non-dipping: n = 11; reverse-dipping: n = 5; normal dipping: n = 1). ♦ Conclusions: We report a novel finding that BP measurement using the BpTRU device is more accurate than home BP measurement in a PD population. Potential explanations for this observation include poor home BP measurement technique, use of poorly validated home BP measurement devices, or a reduced prevalence of white-coat effect among PD patients. Our study also confirms that, in the PD population, BP measurements vary considerably with patient location, time of day, and measurement technique.

show abstract

Home Blood Pressure Measurements for Managing Hypertension in Hemodialysis Patients

Cited by 66 publications

References 58 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

Hemodiyaliz Hastalarının Hipertansiyon Yönetimine İlişkin Evde Yaptıkları Uygulamalar

Blood Pressure Measurement in Peritoneal Dialysis: Which Method is Best?

Contact Info

Product

Resources

About