Out-of-Hemodialysis-Unit Blood Pressure Is a Superior Determinant of Left Ventricular Hypertrophy

Abstract

Abstract-Blood pressures (BPs) obtained in the dialysis unit correlate poorly with ambulatory BP and left-ventricular hypertrophy (LVH). We compared the performance of BP obtained within and outside the dialysis unit as a correlate of LVH. BP was obtained in the dialysis unit using routine and standardized methods and outside the dialysis unit using home and ambulatory BP monitoring in 140 patients (mean age, 56 years; 89 men; 129 blacks; and 59 with diabetes mellitus) on chronic hemodialysis for Ն3 months. Dialysis unit BP recordings were averaged over 2 weeks, and home BP averaged over 1 week.

Determinants of Left Ventricular Mass and Hypertrophy in Hemodialysis Patients Assessed by Cardiac Magnetic Resonance Imaging

“…These observations are consistent with many reports of an association between BP and LVH in HD patients (20,22,23). Although measurement of BP before starting and immediately at the end of dialysis is highly variable, dependent on fluid volume status and the hemodynamic effects of dialysis, it remains the clinical standard.…”

Diagnosing Hypertension by Intradialytic Blood Pressure Recordings

“…However, it would be premature to discontinue home BP monitoring; home BP is associated with left ventricular hypertrophy (26) and mortality in hemodialysis patients (19), relationships that are yet to established for intradialytic BP recordings. Nonetheless, BP measurements obtained during dialysis appear to contain a larger amount of diagnostic information than what is apparent in predialysis and postdialysis BP measurements alone.…”

Weekly Averaged Blood Pressure Is More Important than a Single-Point Blood Pressure Measurement in the Risk Stratification of Dialysis Patients

“…In other words, we may be able to use this measurement instead of using the WAB. Agarwal et al (9) reported the significance of self-recorded home BP three times a day during 1 wk in HD patients and showed that home BP correspond to ambulatory BP and left ventricular hypertrophy in HD patients (10,11). Thus, BP should not be evaluated by one-point measurement before or after dialysis or after waking up but should be evaluated by the average of sequential monitoring during 1 wk.…”