Interpretability of Home Blood Pressure Measurements in Haemodialysis A Post Hoc Analysis of a Randomised Cross-Over Study.

AIM: We aimed to assess patterns of home BP in a maintenance haemodialysis cohort in line with consensus guidelines and determine the agreement with in-centre BP.

METHODS

A post hoc analysis of a pilot-scale, randomised two-period cross-over study comparing self-monitoring of BP over 4 weeks with usual care in 41 haemodialysis patients. Dialysis systolic BP (SBP) was compared with (i) home SBP averaged over 24 h, (ii) home SBP measurements on non-dialysis days between 6 pm-12 am and 6 am-12 pm.

RESULTS

Thirty-three participants with a mean age of 50 ± 14 years provided sufficient blood pressure data. Post-dialysis SBP moderately agreed with home SBP measurements (K = 0.65) when averaged over 2 weeks on non-dialysis days. The limits of agreement and mean bias were minimally different between 2-week averaged home SBP and post-dialysis SBP (mean bias -4.44 mmHg, 95% CI for mean difference between methods -61.63 to 52.59 mmHg), versus 24 h averaged home SBP and post-SBP (mean bias -2.32, limits of agreement -61.63 to 56.98 mmHg). Home SBP measurements were as variable [average real variability (16 ± 6)] as in-centre pre-dialysis SBP average real variability (14 ± 5) and post-SBP average real variability (13 ± 5).

CONCLUSION

This study demonstrates the variability of BP measurement patterns if participants are not limited to measuring BP at a pre-specified frequency. Further studies are needed to assess optimal methods of standardising home BP monitoring in dialysis patients and to evaluate home BP thresholds that can be used as targets in randomised controlled trials.

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CLINICALTRIALS: gov. NCT03403491.