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A Journal on Nephrology and Urology

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Minerva Urologica e Nefrologica 2002 September;54(3):149-56

language: English

How to diagnose hypertension in hemodialysis patients?

Agarwal R.

Indiana University School of Medicine and Richard L. Roudebush VA Medical Center Indianapolis, USA


An accu­rate meas­ure­ment of BP is essen­tial for the diag­no­sis and treat­ment of hyper­ten­sion in any hyper­ten­sive ­patient. ­Although hyper­ten­sion is a big pub­lic ­health bur­den in hemo­di­al­y­sis ­patients and is char­ac­ter­ized by ele­vat­ed sys­tol­ic and ­pulse pres­sure, assess­ment of ­blood pres­sure in ­these ­patients is ­often dif­fi­cult. ­Some prob­lems ­unique in ­this hyper­ten­sive pop­u­la­tion ­include inter­di­a­lyt­ic ­weight ­gain, occur­rence of ­sleep-­apnea and con­se­quent noc­tur­nal hyper­ten­sion, and the inabil­ity to ­take BP in ­both ­arms in ­patients who ­have hemo­di­al­y­sis angioac­cess in the arm. The prob­lems of accu­rate assess­ment of BP are com­pound­ed by the ­lack of stan­dard­ized BP meas­ure­ments and the occur­rence of ­white ­coat ­effect in ­about 1 in 5 ­patients. Pre­cise meas­ure­ment of BP in hemo­di­al­y­sis ­patients ­requires inter­di­a­lyt­ic ambu­la­to­ry BP mon­i­tor­ing. How­ev­er, ­when ambu­la­to­ry BP mon­i­tor­ing is not pos­sible, BP ­obtained in the dial­y­sis ­unit can be ­used in a qual­ita­tive ­sense for pre­dic­tion of hyper­ten­sion in ­these ­patients. A 2-­week aver­aged predial­y­sis BP of >150/85 ­mmHg or a ­postdial­y­sis BP of >130/75 ­mmHg has at ­least 80% sen­si­tiv­ity in diag­nos­ing hyper­ten­sion. Spec­i­fic­ity of at ­least 80% can be ­achieved if predial­y­sis BP of >160/90 ­mmHg or ­postdial­y­sis BP of >140/80 ­mmHg are ­used. How­ev­er, ­poor agree­ment ­between HD ­unit BPs and ­ABPs pre­cludes ­their use for the pre­cise pre­dic­tion of BP. Improv­ing the meas­ure­ment tech­nique in the dial­y­sis ­unit, aver­ag­ing mul­ti­ple BP, ­using a 20 min ­postdial­y­sis read­ing, or ­home BP mon­i­tor­ing can ­improve BP deter­mi­na­tion ­when inter­di­a­lyt­ic BP mon­i­tor­ing is not pos­sible.

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