NDT Advance Access originally published online on July 17, 2007
Nephrology Dialysis Transplantation 2007 22(10):3089-3090; doi:10.1093/ndt/gfm419
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Home BP for assessing haemodialysis hypertension
Email: ragarwal{at}iupui.eduSir,
Moriya et al. [1] demonstrate that weekly averaged blood pressure recorded at home and in the dialysis unit is a better correlate of target organ damage in haemodialysis patients [1]. I would like to point out, contrary to the authors’ suggestion, that I used home BP monitoring for 2 days. I reported self-recorded home BPs three times a day over one week by haemodialysis patients [2]. Subsequently, we demonstrated that home BPs agree well with ambulatory blood pressure and left ventricular hypertrophy in haemodialysis patients [3,4]. Again, these BP measurements were made three times a day over 1 week. Contrary to the authors’ suggestion, that I reported that ‘pre-dialysis diastolic BP, rather than pre-dialysis systolic BP was a better reflection of ambulatory BP’, the correlation coefficient that I reported between pre-dialysis systolic and ambulatory was 0.73 and for pre-dialysis diastolic and ambulatory 0.56 [2]. I also discussed in a review why systolic BP should be the focus of therapy in haemodialysis patients [5].
We previously reported that dialysis unit BPs are poor correlates of ambulatory BP [6]. Thus, it would be an important analysis to remove dialysis unit BP from home BP—it is possible that dialysis unit BPs add little to the value of home BP recording. Home BP devices often come equipped with memory and printers and using this average value at home would assist physicians in managing hypertension. Including dialysis unit BPs in the calculations of weekly average would make this task more onerous. I believe that Moriya et al. confirm the utility of home blood pressure monitoring in Japanese haemodialysis patients. The type of home BP monitor they used should be reported so that their Japanese colleagues can utilize this monitoring device in haemodialysis patients. Taken together, home BP monitoring should be more widely utilized to assess the level of blood pressure in haemodialysis patients.
Conflict of interest statement. None declared.
Indiana University
Indianapolis, USA
References
- Moriya H, Ohtake T, Kobayashi S. Aortic stiffness, left ventricular hypertrophy and weekly averaged blood pressure (WAB) in patients on haemodialysis. Nephrol Dial Transplant (2007) 22:1198–1204.
[Abstract/Free Full Text] - Agarwal R. Role of home blood pressure monitoring in hemodialysis patients. Am J Kidney Dis (1999) 33:682–687.[Web of Science][Medline]
- Agarwal R, Brim NJ, Mahenthiran J, Andersen MJ, Saha C. Out-of-hemodialysis-unit blood pressure is a superior determinant of left ventricular hypertrophy. Hypertension (2006) 47:62–68.
[Abstract/Free Full Text] - Agarwal R, Andersen MJ, Bishu K, Saha C. Home blood pressure monitoring improves the diagnosis of hypertension in hemodialysis patients. Kidney Int (2006) 69:900–906.[CrossRef][Web of Science][Medline]
- Agarwal R. Systolic hypertension in hemodialysis patients. Semin Dial (2003) 16:208–213.[CrossRef][Web of Science][Medline]
- Agarwal R, Peixoto AJ, Santos SF, Zoccali C. Pre and post dialysis blood pressures are imprecise estimates of interdialytic ambulatory blood pressure. Clin J Am Soc Nephrol (2006) 1:389–398.
[Abstract/Free Full Text]
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