Comparison of Dialysis Unit and Home Blood Pressures: An Observational Cohort Study

Rationale & Objective: Prior studies of patients receiving maintenance hemodialysis have shown that, on average, blood pressure (BP) measured predialysis is higher than BP measured at home. We hypothesized that a subset of hemodialysis patients has BP that is higher when measured at home than when measured predialysis and this subgroup of patients has a higher prevalence of left ventricular hypertrophy. Study Design: Prospective cohort. Setting & Participants: 97 hypertensive hemodialysis patients enrolled in the Blood Pressure in Dialysis Study (BID), a randomized trial of comparing target predialysis BP <= 140/90 to 155-165/90 mm Hg. Exposure: Differences between predialysis and next-day home systolic BP measured >= 6 times over 1 year. Outcome: Left ventricular mass index (LVMI) by cardiac magnetic resonance imaging. Analytical Approach: A hierarchical clustering analysis divided patients into 3 clusters based on the average and variability of differences in systolic predialysis and home BP. Clusters were compared with respect to clinical factors and LVMI. Results: Mean differences between predialysis and home systolic BP were 19.1 (95% CI, 17.0 to 21.1) mm Hg for cluster 1 (home lower), 3.7 (95% CI, 1.6 to 5.8) mm Hg for cluster 2 (home and predialysis similar), and -9.7 (95% CI, -12.0 to -7.4) mm Hg for cluster 3 (home higher). Systolic BP declined during dialysis in clusters 1 and 2 but increased in cluster 3. Interdialytic weight gains did not differ. After adjusting for sex and treatment arm, LVMI was higher in cluster 3 than in clusters 1 and 2: differences in means of 10.6 +/- 4.96 (SE) g/m(2) (P = 0.04) and 12.0 +/- 5.08 g/m(2) (P = 0.02), respectively. Limitations: Limited statistical power. Conclusions: Nearly one-third of participants had home BPs higher than predialysis BPs. These patients had LVMI higher than those with similar or lower BPs at home, indicating that their BP may have been undertreated.

Automated summary

The study found that nearly one-third of hemodialysis patients had higher blood pressure measured at home than before dialysis, and these patients had higher left ventricular mass index, suggesting potential undertreatment of hypertension.