Document Detail


Blood pressure measurement in peritoneal dialysis: which method is best?
MedLine Citation:
PMID:  23547279     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The optimal approach to monitoring blood pressure (BP) in the peritoneal dialysis (PD) population is unclear. Ambulatory BP monitoring reliably predicts prognosis, but can be inconvenient. The accuracy of home BP monitoring in this population is unproven. The automated BpTRU device (BpTRU Medical Devices, Coquitlam, BC, Canada), which provides an average of up to 6 successive in-office BP measurements, has not been studied in this patient group.
METHODS: We studied 17 patients (average age: 54 ± 12 years; 12 men, 5 women; 94% on automated PD) attending a single center. All patients underwent office, home, BpTRU, and ambulatory BP measurement. The reference standard for analysis was daytime ambulatory BP. Correlation between the referent method and each comparator method was determined (Pearson correlation coefficient), and Bland-Altman scatter plots depicting the differences in the BP measurements were constructed.
RESULTS: Mean office BP (126.4 ± 16.9/78.8 ± 11.6 mmHg) and BpTRU BP (123.8 ± 13.7/80.7 ± 11.1 mmHg) closely approximated mean daytime ambulatory BP (129.3 ± 14.8/78.2 ± 7.9 mmHg). Mean home BP (143.8 ± 15.0/89.9 ± 28.1 mmHg) significantly overestimated mean daytime systolic BP by 14.2 mmHg (95% confidence interval: 4.3 mmHg to 24.1 mmHg; p = 0.008). Bland-Altman plots demonstrated poorest agreement between home BP and daytime ambulatory BP. No patient had "white-coat hypertension," and only 1 patient had false-resistant hypertension. Most patients showed abnormal nocturnal dipping patterns (non-dipping: n = 11; reverse-dipping: n = 5; normal dipping: n = 1).
CONCLUSIONS: We report a novel finding that BP measurement using the BpTRU device is more accurate than home BP measurement in a PD population. Potential explanations for this observation include poor home BP measurement technique, use of poorly validated home BP measurement devices, or a reduced prevalence of white-coat effect among PD patients. Our study also confirms that, in the PD population, BP measurements vary considerably with patient location, time of day, and measurement technique.
Authors:
Michelle M O'Shaughnessy; Martin Durcan; Sinead M Kinsella; Matthew D Griffin; Donal N Reddan; David W Lappin
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Publication Detail:
Type:  Journal Article; Observational Study     Date:  2013-04-01
Journal Detail:
Title:  Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis     Volume:  33     ISSN:  1718-4304     ISO Abbreviation:  Perit Dial Int     Publication Date:    2013 Sep-Oct
Date Detail:
Created Date:  2013-10-17     Completed Date:  2014-07-10     Revised Date:  2014-09-02    
Medline Journal Info:
Nlm Unique ID:  8904033     Medline TA:  Perit Dial Int     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  544-51     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Blood Pressure*
Blood Pressure Monitoring, Ambulatory / instrumentation*
Cross-Sectional Studies
Equipment Design
Female
Follow-Up Studies
Humans
Hypertension / diagnosis*,  epidemiology,  etiology
Ireland / epidemiology
Male
Middle Aged
Peritoneal Dialysis / adverse effects*
Prevalence
Prognosis
Reproducibility of Results
Retrospective Studies
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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