Measurement of Blood Pressure in Chronic Kidney Disease: Time to Change Our Clinical Practice - A Comprehensive Review

Nagaraju, Shankar Prasad; Shenoy, Srinivas Vinayak; Rao, Indu Ramachandra; Bhojaraja, Mohan V; Rangaswamy, Dharshan; Prabhu, Ravindra

doi:10.2147/ijnrd.s343582

Cited by 6 publications

(4 citation statements)

References 84 publications

(146 reference statements)

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“…2,6 Furthermore, HBPM is an important predictor of target organ damage and provides better prognostic information than office BP and, although the evidence base is still developing, HBPM is suggested by Hypertension Canada to be used in conjunction with standardized office measurement for long-term BP monitoring. 2,[6][7][8][9][10][11][12] There exists a paucity of data on uptake, barriers, and facilitators of HBPM in nondialysis CKD patients, a group likely to benefit from improved BP control due to a high prevalence of hypertension and cardiovascular disease and BP control slowing the trajectory of kidney function decline. 4,[13][14][15][16] Patient-centered care, which focuses on enabling patients to self-manage aspects of their health care, is encouraged in many CKD management guidelines.…”

Section: Introductionmentioning

confidence: 99%

The Patient-Provider Gap: A Cross-sectional Survey to Understand Barriers and Motivating Factors for Home Blood Pressure Monitoring in a CKD Cohort

Borkum

Levin

Williams³

et al. 2023

Can J Kidney Health Dis

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Background: Blood pressure (BP) management can decrease morbidity and mortality in chronic kidney disease (CKD) patients. Evidence-based hypertension guidelines endorse home BP monitoring (HBPM), and the growing use of virtual health has highlighted the need for HBPM. A comprehensive understanding of HBPM adoption in our province is lacking. Objective: To identify the baseline practices, perspectives, barriers, and enablers in both providers and patients in our kidney care clinics regarding HBPM. Ultimately, this will inform the development of a provincial intervention that empowers providers to both increase patient understanding and equip them for accurate and reliable home BP measurement. Design: Cross-sectional, descriptive study using online survey methodology. Setting: Kidney care clinic network in the province of British Columbia, Canada. Patients or Sample or Participants: Kidney care clinic staff and patients who perform HBPM. Methods: Data were collected using semi-structured online surveys, one for staff and one for patients and/or caregivers. These surveys were developed by an interdisciplinary working group that included patient partners and addressed some key components of the implementation of an HBPM program (including perceived barriers to uptake, education, and adoption of best practices). Results: In all, 46 patients and 43 staff responded to the survey from 16 kidney care clinics. Of the patients 53% were women, and the most common age range was 60 to 69 years (25%); 93% of the staff respondents were women and 63% were nurses. We identified numerous areas of discordance between providers and patients and the need for improvement from the perspective of implementing best practices from hypertension guidelines, both in staff teaching and patient usage of HBPM. Blood pressure targets were not known to 18% of patients and 39% of patients had received a BP target from their kidney care clinic team; 89% of patients had not had their upper arm circumference measured for cuff size. Furthermore, 54% of patients knew what to do when their BP is off-target. All recognized the benefits of HBPM, providers were more likely to perceive anxiety as a barrier relative to patients, and patients were more likely to report expense as a barrier than providers. Limitations: This study includes only a single provincial health care system limiting generalizability to other jurisdictions and sampled a small subset of patients and providers. Conclusions: The systematic evaluation of education, understanding, implementation of best practices, and barriers and motivating factors for HBPM from both patient and clinician perspectives is an important step in designing strategies to improve the use of HBPM. Given differences in staff and patient perspectives, targeted interventions based on these responses may lead to improved use of HBPM, and ultimately enhance hypertension self-management and BP control in our CKD patients.

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Section: Introductionmentioning

confidence: 99%

The Patient-Provider Gap: A Cross-sectional Survey to Understand Barriers and Motivating Factors for Home Blood Pressure Monitoring in a CKD Cohort

Borkum

Levin

Williams³

et al. 2023

Can J Kidney Health Dis

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“…Although standardized BP measurement is recommended in CKD patients by the current KDIGO guidelines, the specific recommendations for ESKD patients on dialysis are still lacking [ 28 ]. Traditionally, HTN in HD patients has been assessed using peridialytic BP measurements taken before or after dialysis [ 2 , 26 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…We are aware that the BP assessment in the peridialytic period in ESKD patients may encounter numerous methodological difficulties resulting from the presence of arteriovenous fistula or former multiple vascular access surgeries (preventing BP measurement on both or any arm), anxiety and discomfort during dialysis and severe vascular calcifications [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Apparently Resistant Hypertension in Polish Hemodialyzed Population: Prevalence and Risk Factors

Symonides,

Lewandowski,

Marcinkowski

et al. 2023

JCM

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Background: The aim of this study was to assess the prevalence, characteristics, and determinants of apparent treatment-resistant hypertension (aTRH) in an unselected large population of patients with end-stage kidney disease (ESKD) treated with hemodialysis (HD) throughout the country. Methods: A database of 5879 patients (mean age 65.2 ± 14.2 years, 60% of males receiving hemodialysis) was obtained from the biggest provider of hemodialysis in the country. Hypertension and aTRH were defined using pre- or/and post-dialysis BP values. Patients with and without aTRH (non-aTRH) were compared. Results: Using pre- and post-dialysis criteria, hypertension was diagnosed in 90.7% and 89.1% of subjects, respectively. According to pre- and post-dialysis blood pressure criteria, aTRH incidences were 40.9% and 38.4%, respectively. The hypertensive patients with aTRH versus non-aTRH were younger, had a higher rate of cardiovascular disease, lower dialysis vintage, shorter time on dialysis, higher eKt/V, higher ultrafiltration, higher pre- and post-dialysis BP and HR, and higher use of antihypertensive drugs. Factors that increase the risk of aTRH according to both pre- and post-dialysis BP criteria were age—OR 0.99 [0.98–0.99] and 0.99 [0.98–0.99], the history of CVD 1.26 [1.08–1.46] and 1.30 [1.12–1.51], and diabetes 1.26 [1.08–1.47] and 1.28 [1.09–1.49], adjusted OR with 95% CI. Conclusions: In the real-life world, as much as 40% of HD patients may have aTRH. In ESKD HD patients, aTRH seems to be multifactorial, influenced by patient-related rather than dialysis-related factors. Various definitions of aTRH preclude easy comparisons between studies.

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“…Although recent guidelines (ESH and ACC/AHA) [21,28] recommend out-of-office monitoring in certain circumstances, including suspected white-coat and masked hypertension, KDIGO recommends that out-of-office BP measurement be used to complement standardized office BP measurement. Types of outof-office BP measurement includes: Ambulatory BP Monitoring Ambulatory BP monitoring (ABPM) has been available since the 1980s and measures BP at intervals (usually every 20 min during the day and every 30 min at night) during the day and night from an appropriately sized cuff applied to the non-dominant arm [38] . ABPM is able to distinguish and identify all types of hypertension, including "white-coat", "masked", "nocturnal", and "non-dippers", all of which are common in patients with CKD [39] .…”

Section: Out-of-office Bp Measurementmentioning

confidence: 99%

Telemonitoring in hypertension management for patients with chronic kidney disease: a narrative review

Okpechi¹,

Ringrose²,

Padwal³

et al. 2023

Conn Health

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Hypertension is a major cause of cardiovascular disease worldwide and a major cause of morbidity and mortality in patients with chronic kidney disease (CKD). The Systolic Blood pressure Intervention Trial (SPRINT) demonstrated that blood pressure (BP) measurement techniques may have an impact on the achievement of outcomes. Home BP monitoring (HBPM) has several advantages over office BP recordings, including avoidance of white-coat reaction, ability to diagnose white-coat and masked hypertension, detection of BP variability, and better ability to predict cardiovascular morbidity and mortality, all of which commonly occur in CKD. The addition of telemonitoring and management support to HBPM allows remote monitoring, especially when close contact is difficult (e.g., patients in remote/rural areas, pandemic, natural disaster, or patients treated with home dialysis). Although there are few studies that have assessed the efficacy of home BP telemonitoring (HBPT) in patients with CKD, these studies suggest the benefits of HBPT for BP control and even limited evidence that it may improve kidney function. This review, using limited available evidence, assesses the roles of HBPT in patients with CKD, barriers to HBPT implementation in the care of patients with CKD, and discusses newer technologies that can be leveraged in the management of hypertension in patients with CKD.

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Measurement of Blood Pressure in Chronic Kidney Disease: Time to Change Our Clinical Practice - A Comprehensive Review

Cited by 6 publications

References 84 publications

The Patient-Provider Gap: A Cross-sectional Survey to Understand Barriers and Motivating Factors for Home Blood Pressure Monitoring in a CKD Cohort

The Patient-Provider Gap: A Cross-sectional Survey to Understand Barriers and Motivating Factors for Home Blood Pressure Monitoring in a CKD Cohort

Apparently Resistant Hypertension in Polish Hemodialyzed Population: Prevalence and Risk Factors

Telemonitoring in hypertension management for patients with chronic kidney disease: a narrative review

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