Comparison of 44‐Hour and Fixed 24‐Hour Ambulatory Blood Pressure Monitoring in Dialysis Patients

Abstract

The two most commonly used strategies to evaluate dialysis patients' blood pressure (BP) level are 44-hour and 24-hour ambulatory blood pressure monitoring (ABPM). The objective of this study was to find an appropriate 24-hour period that correlated well with the 44-hour BP level and determine the differences between these strategies. In a group of 51 dialysis patients, the authors performed 44-hour ABPM and extracted data for a fixed 24-hour ABPM. The fixed 24-hour ABPM started at 6 AM on the nondialysis day. A strong correlation was found between all parameters of 44-hour and the fixed 24-hour ABPM, with paired sample t test showing only small magnitude changes in a few parameters.Both 24-hour ABPM and 44-hour ABPM were superior to clinic BP in predicting left ventricular mass index (LVMI) by multiple regression analysis. It was found that 44-hour ambulatory arterial stiffness index (AASI), but not 24-hour AASI, had a positive association with LVMI (r=0.328, P=.021). However, after adjustment for 44-hour systolic blood pressure, this association disappeared. Fixed 24-hour ABPM is a good surrogate of 44-hour ABPM to some extent, while 44-hour ABPM can provide more accurate and detailed information.

Poor Agreement Between Dialysis Unit Blood Pressure and Interdialytic Ambulatory Blood Pressure

“…Although there were attempts to improve the accuracy of dialysis unit BP, it is not yet appropriate for dialysis unit BP to substitute interdialytic ABP, with the latter being expensive, inconvenient, and uncomfortable. Alternative approaches, including shortening the interval of ABP measurement and home BP monitoring, have been tested and the results are promising and of clinical importance . More studies are warranted to address this issue.…”

“…Alternative approaches, including shortening the interval of ABP measurement and home BP monitoring, have been tested and the results are promising and of clinical importance. [25][26][27] More studies are warranted to address this issue.…”

Association of betaine with blood pressure in dialysis patients

“…The current study's monitoring program began in the morning of a midweek non‐dialysis day and was terminated before the next dialysis session using a SpaceLabs 90217 monitor. We have previously shown that 24‐hour ambulatory blood pressure monitoring starting from the non‐dialysis day agrees well with 44‐hour monitoring and therefore can be used as a good surrogate for 44‐hour monitoring . Patients were instructed to keep their arm still at measurement and follow their daily activity.…”

“…We have previously shown that 24-hour ambulatory blood pressure monitoring starting from the non-dialysis day agrees well with 44-hour monitoring and therefore can be used as a good surrogate for 44-hour monitoring. 12 Patients were instructed to keep their arm still at measurement and follow their daily activity. Blood pressure was measured at 20-minute intervals in the daytime (6:00 am-10:00 pm) and at 30-minute intervals in the nighttime (10:00 pm-6:00 am).…”

Ambulatory Blood Pressure Monitoring in Clinical Practice: A Review

“…As noted in the Introduction, ambulatory blood pressure monitoring generates much more information than the single (typically daytime) 'snapshot in time' reading yielded by clinic measurement by providing a profile of blood pressure behavior over a 24-hour (or longer 17 ) period, and, therefore, how blood pressure throughout this period can be beneficially influenced by antihypertensive therapy. The challenges, limitations, and questionable veracity of (office) blood pressure measurement have been extensively discussed.…”