Table 4.
Studies on BP Measurement Techniques in a Special Population of CKD
| Study Author and Characteristics | BP Measurement Technique | Outcomes |
|---|---|---|
| End-stage kidney disease and dialysis: | ||
| 1. Pre- and post-dialysis BP Agarwal R et al, 200650 Comparison between dialysis unit BP (pre-and-post) and ambulatory BP (ABP) |
Metaanalysis The most commonly used method in most studies was an average of 12 predialysis and post-dialysis readings obtained in the month preceding the study. Space Labs 90,207, 48 hr, including the first and second dialysis sessions for ABP in most studies. |
Predialysis diastolic BP overestimated ABP and post-dialysis BP underestimated ABP |
| 2. Home BP Agarwal R et al, 200641 Using interdialytic ambulatory blood pressure recordings as the reference standard, we compared the performance of routine, standardized, and home BP monitoring in 104 predominantly black patients on chronic hemodialysis for at least 3 months. |
Dialysis unit BP recordings were averaged over 2 weeks and home BP over 1 week. Home BP monitoring: BP three times daily – on waking up, between noon and 1900 and at bedtime over 1 week using a validated self-inflating automatic oscillometric device. |
Systolic BP threshold of >150 mmHg at home averaged over 1 week was comparable to diagnosis by ambulatory BP monitoring |
| 3. ABPM Sarafidis PA et al, 201949 396 hemodialysis patients underwent 48-h ABPM monitoring during a regular hemodialysis session and the subsequent interdialytic interval |
A validated ABPM monitor was fitted in the non-fistula arm with a cuff of appropriate size and ABPM monitoring was started. The device was set to measure BP every 20 min during the daytime and every 30 min during the nighttime for a complete 48-h standard intra- and inter-dialytic period. | The prevalence of hypertension in hemodialysis patients assessed by 48-h ABPM monitoring is very high and supports the use of ABPM for HTN diagnosis and treatment in the HD population. |
| Kidney transplant recipients: | ||
| Agena et al. 201166 Comparative study between office BP, Home BP, and ABPM in 183 KTRs |
Office BP – Performed by a nurse after a rest period of 5 min, 3 readings by the automatic oscillometric device. Mean of last 2 readings taken. Home BP – BP measured twice a day, before breakfast and before dinner, three consecutive times on each occasion and for five consecutive days. An automated oscillometric device was used. ABPM – Spacelab TM ABPM device used. Day time - every 20 min and night time - every 30 min BP measured. |
Both office BP and Home BP over diagnosed patients with uncontrolled hypertension when ABPM was taken as standard. Home BP recording had more closer recordings to ABPM as compared to office BP |
| Wen KC et al. 201267 Comparative study between 24-hour ABPM and Office BP measurement in 244 prevalent KTRs |
Office BP – Single sitting BP measurement after 5 min rest by a trained nurse in a quiet room with mercury sphygmomanometer by auscultatory method ABPM – Spacelab TM oscillometric unit – day time readings every 15 min and night time every 30 min |
Office BP overestimated both daytime ABPM and 24-hour ABPM |
| Czyżewski et al. 201468 Comparative study between 24-hour ABPM and office BP in 50 KTRs |
Office BP – 10 min of rest followed by mean of 2 BP readings taken 2 min apart rest as per ECC/ESH 2013 guidelines ABPM - SpaceLabsTM 90217 device. 20 min intervals for daytime reading and 30 min for nighttime reading |
No correlation was seen between office BP and 24-hour ABPM. 18% had masked hypertension, 10% had white coat hypertension. only 16% showed nocturnal dipping in BP |
| Bhatnagar et al. 201869 Comparative study between conventional office BP versus SPRINT type automated office BP in 120 KTRs |
Conventional Office BP – rest period of 3 min, single BP recording in the presence of a doctor SPRINT type BP – Unattended BP after resting for 5 min, an average of 3 readings in 1 min interval HEM 907 XL, OMRON machine used for both recordings |
Automated office BP taken in the protocol of the SPRINT trial showed significantly lower SBP/DBP than the conventional single reading of oscillometric BP |
| Mallamaci et al. 201970 Long term comparative study between office BP and 24-hour ABPM in 260 KTRs |
Office BP – Sitting position, mean of 2–3 readings taken at 1–2 min intervals by any standard and calibrated instrument ABPM – SpacelabsTM machine. BP measurement frequency every 15 min both during the day and night |
74% of patients had nocturnal HTN. There was poor agreement between office BP and ABPM. In 37% of visits, office BP lead to wrongful anti-hypertensive adjustments |
| Pediatric CKD: | ||
| The ESCAPE Trial:73 Multicenter RCT (33 European pediatric nephrology units) 385 children Age: 3 to 18 years CKD with eGFR 15 to 80 mL per minute per 1.73 m2 of body-surface area) Fixed high dose of Ramipril for both groups (6 mg/ m2 of BSA) intensified blood-pressure control (with a target 24-hour mean arterial pressure below the 50th percentile) or conventional blood-pressure control (mean arterial pressure in the 50th to 95th percentile) |
24-hour ABPM was performed every 6 months over 5 years Spacelabs 90,207 oscillometric devices (Spacelabs Healthcare) Measurements were performed every 15 min during daytime and every 20–30 min during nighttime |
Intensified blood-pressure control, with target 24-hour blood-pressure levels in the low range of normal, confers a substantial benefit for slowing the progression of renal disease among children with progressive chronic kidney disease |
| CKiD trial:76 Twenty-Four–Hour Ambulatory Blood Pressure versus Clinic Blood Pressure Measurements and Risk of Adverse Outcomes in Children with CKD 513 participants Observational study |
Clinic BP: Performed by trained and certified personnel by auscultation method. Annually using an aneroid sphygmomanometer with an appropriately sized cuff. After at least 5 min of quiet rest, 3 consecutive seated readings were obtained at each study visit 30 seconds apart and the average of those 3 readings was considered the clinic BP for that visit ABPM: 24-hour Ambulatory BP monitoring was performed during the CKiD Study using a SpaceLabs 90,217 monitor (SpaceLabs Healthcare), with BPs taken every 20 min over 24 hours |
Clinic BPs taken in a protocol-driven setting are not consistently inferior to ambulatory BP in the discrimination of BP-related adverse outcomes in children with CKD |
Abbreviations: KTRs, Kidney transplant recipients; ESCAPE, Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CKD in Pediatric Patients; CKiD, Chronic Kidney Disease in Children Study.