Home blood pressure monitoring improves the diagnosis of hypertension in hemodialysis patients
Open accessAbstract
Using interdialytic ambulatory blood pressure (BP) recordings as the reference standard, we compared the performance of routine, standardized and home BP monitoring in 104 predominantly black patients on chronic hemodialysis for at least 3 months. Dialysis unit BP recordings were averaged over 2 weeks and home BP over 1 week. Awake ambulatory BP of > or =135 mmHg systolic or > or =85 mmHg diastolic was taken as evidence of hypertension. Average awake ambulatory BP was 128.1+/-21.6/73.5+/-13.5 mmHg, home BP 141.3+/-21.9/78.7+/-11.9 mmHg, standardized pre-dialysis BP 141.7+/-22.6/74.2+/-13.5 mmHg and post-dialysis 119.9+/-20.5/69.1+/-13.1 mmHg, routine pre-dialysis 145.4+/-21.8/79.0+/-13.1 mmHg and post-dialysis 131.5+/-19.2/72.5+/-11.4 mmHg. Sixty-three percent of the patients had well-controlled BP by ambulatory BP monitoring and isolated diastolic hypertension was rare (3%). The standard deviation of the differences between ambulatory and routine pre-dialysis BP was 17.6 mmHg, routine post-dialysis was 16.1 mmHg, standardized pre-dialysis was 16.4 mmHg, standardized post-dialysis was 14.1 mmHg, and home BP was 14.2 mmHg. The area under receiver operating characteristic curves was similar for home and standardized BP but lower for routine BP. Home systolic BP of > or =150 mmHg averaged over 1 week had the best combination of sensitivity (80%) and specificity (84.1%) in diagnosing systolic hypertension--present in 94% of the hypertensive dialysis patients. Home BP monitoring is similar to standardized recording of BP in hemodialysis patients. A systolic BP threshold of 150 mmHg at home averaged over 1 week serves as a useful predictor of hypertension diagnosed by ambulatory BP monitoring.
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Patients with CKD on haemodialysis are profoundly different from patients with CKD not on dialysis because of varying states of volume excess and volume accumulation in the interdialytic period.
“Patients with CKD on haemodialysis are profoundly different from patients with CKD who are not on dialysis; this is so because of varying states of volume excess among patients and volume accumulation in the interdialytic period [204–206].”
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Capítulo 1 - Conceituação, Epidemiologia e Prevenção Primária
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“Within this context, home blood pressure monitoring (HBPM) is an interesting option to blood pressure measurement among haemodialysis patients since it shares the same advantages of the ABPM [13–15], besides showing good acceptability by patients when the procedure needs to be repeated [16].”
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Self-citationOut-of-office blood pressure monitoring in chronic kidney disease
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“HBPM has been shown to be superior to measurements made in the dialysis unit for predicting ambulatory hypertension.(146) Children”
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“(9) reported the significance of self-recorded home BP three times a day during 1 wk in HD patients and showed that home BP correspond to ambulatory BP and left ventricular hypertrophy in HD patients (10,11).”
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“HBPM can be used to confirm the diagnosis of hypertension, identify and reduce the need for medications in those with white coat effect, identify those with masked hypertension (blood pressure that is higher outside of the health professional’s office), improve medication adherence, and assist in the management of blo…”
BackgroundMethodDecreased pulse pressure during hemodialysis is associated with improved 6-month outcomes
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“Materials and Methods Participants The cross-sectional data on part of this cohort have previously been reported (3,13).”
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“Discussion The main findings of the present study are: (1) home BP increases over time after hemodialysis treatment; (2) this relationship is non-linear and plateaus after approximately 2 days; (3) probing dry-weight does not perturb the time-dependent relationship of home BP but steepens the slope for ambulatory BP;…”
ResultSelf-citationMarshall, M., Vandal, A., de Zoysa, J., Gabriel, R., Haloob, I., Hood, C. J., Irvine, J. H., Matheson, P. J., Mcgregor, D. O., Rabindranath, K., et al. (2020) · Journal of the American Society of Nephrology · doi:10.1681/asn.2019090877 · Cited by 34 · see citing works
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“Although peridialysis BP recorded from 3-6 HD sessions have been reported to be poorly correlated with end-organ damage and cardiovascular outcomes [14-16], the discrepancy was suggested to result from the highly variable nature of peridialysis BP levels [19,24,25].”
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“measured BP using a standardized technique wherein BPs were recorded in triplicate before and after dialysis for six consecutive dialysis treatments [7].”
MethodSelf-citationImpact of Hemocontrol on Hypertension, Nursing Interventions, and Quality of Life
Accent]ziel, C. A. A. D. A., Bouchard, J., Zellweger, M., & Madore, F. (2007) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.04171206 · Cited by 38 · see citing works
“In addition, in a recent study, home BP measurements were found to be reliable to estimate systolic hypertension when compared with ambulatory BP measurements (27).”
BackgroundResultInfluentialDiagnosis and treatment of hypertension in dialysis patients: a systematic review
Kim, I., Kim, S., Yoo, T., & Kim, J.-K. (2023) · Clinical Hypertension · doi:10.1186/s40885-023-00240-x · Cited by 39 · see citing works
“Compared with peridialytic BP measurement in the HD unit, home BP measurement has a stronger correlation with the mean 44-hour ABPM, higher short-term reproducibility, and better prediction of adverse outcomes [21].”
BackgroundMethodCapítulo 3 - Avaliação Clínica e Complementar
Malachias, M. V. B., Souza, W., Plavnik, F. L., Rodrigues, C., Brandão, A., Neves, M. F., Bortolotto, L. A., Franco, R., Figueiredo, C., Jardim, P., et al. (2016) · Arquivos Brasileiros de Cardiologia · doi:10.5935/abc.20160153 · Cited by 36 · see citing works
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“Given the high frequency of non-dipping and nocturnal hypertension in endstage renal disease, the problem of masked hypertension—the Achilles’s heel of home BPmonitoring—may be even more serious than in the general population.”
BackgroundMethodResultInfluentialAmbulatory Blood Pressure and Cardiovascular Events in Chronic Kidney Disease
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Self-citationResistant Hypertension in Dialysis: Epidemiology, Diagnosis, and Management
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“Never 0 (0) 2 (13) 24 (20) 37 (34) 29 (41) 20 (47) 3 (50) 115 (31)”
Self-citationCapítulo 14 – Crise Hipertensiva
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“But by far the best way to monitor the blood pressure in these patients would be at home by the patient by an automatic ambulatory blood pressure monitoring [16,17].”
BackgroundVolume Overload in Dialysis: The Elephant in the Room, No One Can See
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Self-citationPro: Ambulatory blood pressure should be used in all patients on hemodialysis.
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“Readings will be made 3 times per day (on waking up, between noon and 1900, and before bed) during the 7days immediately prior to 3, 6, 9 and 12 months [150,157,158].”
MethodZhou, Y.-L., Liu, J., Sun, F., Ma, L.-J., Han, B., Shen, Y., & Cui, T.-G. (2010) · American Journal of Nephrology · doi:10.1159/000315135 · Cited by 61 · see citing works
Peridialytic, Intradialytic, and Interdialytic Blood Pressure Measurement in Hemodialysis Patients
Sinha, A. D., & Agarwal, R. (2009) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2009.07.004 · Cited by 28 · see citing works
Self-citationZhang, H.-J., Preciado, P., Wang, Y.-D., Meyring-Wosten, A., Raimann, J., Kooman, J., van der Sande, F. M., Usvyat, L., Maddux, D. W., Maddux, F., et al. (2020) · Nephrology, Dialysis and Transplantation · doi:10.1093/ndt/gfz289 · Cited by 19 · see citing works
“Home BP measurement provides a valuable alternative [33–35], but has gained only limited traction.”
Management of hypertension in hemodialysis patients
Agarwal, R. (2006) · Hemodialysis International · doi:10.1111/j.1542-4758.2006.00102.x · Cited by 20 · see citing works
Self-citationCapítulo 9 - Hipertensão Arterial na gestação
Malachias, M. V. B., Souza, W., Plavnik, F. L., Rodrigues, C., Brandão, A., Neves, M. F., Bortolotto, L. A., Franco, R., Poli‐de‐Figueiredo, C. E., Jardim, P., et al. (2016) · Arquivos Brasileiros de Cardiologia · doi:10.5935/abc.20160159 · Cited by 21 · see citing works
Median Intradialytic Blood Pressure Can Track Changes Evoked by Probing Dry-Weight
Agarwal, R., & Light, R. P. (2010) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.08341109 · Cited by 19 · see citing works
“Two methods are commonly used to record BP outside the dialysis unit: interdialytic ambulatory BP and home BP measurements (11).”
MethodSelf-citationZhou, Y.-L., Liu, J., Ma, L.-J., Sun, F., Shen, Y., Huang, J., & Cui, T.-G. (2014) · Artificial Organs · doi:10.1111/aor.12156 · Cited by 20 · see citing works
“One week averaged home systolic BP of ≥150 mm Hg (15), which had the best combination of sensitivity and specificity to predict hypertension diagnosed by the gold standard of”
BackgroundRenal Association Clinical Practice Guideline on Cardiovascular Disease in CKD
Holt, S. G., & Goldsmith, D. J. A. (2011) · Nephron Clinical Practice · doi:10.1159/000328065 · Cited by 18 · see citing works
The controversies of diagnosing and treating hypertension among hemodialysis patients
Agarwal, R. (2012) · Seminars in dialysis · doi:10.1111/j.1525-139x.2012.01092.x · Cited by 19 · see citing works
“For example, in a validation study that used ambulatory BP measurements as a reference standard, home BP recordings had excellent diagnostic test characteristics (17).”
ResultSelf-citationBlood pressure management in children on dialysis
Paglialonga, F., Consolo, S., Edefonti, A., & Montini, G. (2017) · Pediatric Nephrology · doi:10.1007/s00467-017-3666-8 · Cited by 17 · see citing works
Chazot, C. (2009) · JN. Journal of Nephrology (Milano. 1992) · doi:10.1093/joneph/22.5.587 · Cited by 17 · see citing works
Vaios, V., Georgianos, P. I., Vareta, G., Dounousi, E. C., Dimitriadis, C., Eleftheriadis, T., Papagianni, A. A., Zebekakis, P. E., & Liakopoulos, V. (2019) · Hypertension · doi:10.1161/hypertensionaha.119.13443 · Cited by 17 · see citing works
“Standardized clinic systolic BP overestimated ambulatory daytime systolic BP on average by 5.02 mm Hg with 95% limits of agreement ranging from −17.92 to 27.96 mm Hg. Similarly, 1-week averaged home systolic BP overestimated ambulatory daytime systolic BP by 4.23 mm Hg, again with wide 95% limits of agreement (−16.05…”
BackgroundMethodResultInfluentialFagugli, R. M., Ricciardi, D., Rossi, D., Gaetano, A. D., & Taglioni, C. (2009) · Nephrology · doi:10.1111/j.1440-1797.2009.01090.x · Cited by 17 · see citing works
Sarafidis, P., Theodorakopoulou, M. P., Loutradis, C., Iatridi, F., Alexandrou, M., Karpetas, A., Koutroumpas, G., Raptis, V., Ferro, C., & Papagianni, A. (2021) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2021.01.022 · Cited by 14 · see citing works
Blood pressure in hemodialysis: targets?
Georgianos, P., & Agarwal, R. (2017) · Current opinion in nephrology and hypertension · doi:10.1097/mnh.0000000000000359 · Cited by 13 · see citing works
“All rights rese publication of those guidelines, a growing body of evidence suggests that out-of-dialysis BP recordings are superior to predialysis and postdialysis BP in diagnosing hypertension [12,13], detecting evidence of target-organ damage [14], prognosticating the risk for future cardiovascular events and morta…”
BackgroundSelf-citationSanders, P. W. (2007) · Seminars in Dialysis · doi:10.1111/j.1525-139x.2007.00316.x · Cited by 14 · see citing works
Georgianos, P., & Agarwal, R. (2019) · Seminars in dialysis · doi:10.1111/sdi.12837 · Cited by 13 · see citing works
Self-citationChallenges in blood pressure measurement in patients treated with maintenance hemodialysis.
Roberts, M., Pilmore, H., Tonkin, A., Garg, A., Pascoe, E., Badve, S., Cass, A., Ierino, F., & Hawley, C. (2012) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2012.04.026 · Cited by 12 · see citing works
Khangura, J. K., Culleton, B. F., Manns, B., Zhang, J., Barnieh, L., Walsh, M. W., Klarenbach, S. W., Tonelli, M. A., Sarna, M. A., Hemmelgarn, B. R., et al. (2010) · BMC Nephrology · doi:10.1186/1471-2369-11-13 · Cited by 15 · see citing works
“Although the most accurate BP measurement technique among patients on HD is unknown, it has been demonstrated that casual dialysis-unit BP measurements differ considerably when compared to ambulatory and standardized BP measurements[12-14], and correlate poorly with target organ damage[13].”
Ekart, R., Kanič, V., Pečovnik-Balon, B., Bevc, S., & Hojs, R. (2012) · Kidney & Blood Pressure Research · doi:10.1159/000336357 · Cited by 18 · see citing works
Hypertension in end-stage renal disease: different measures and their prognostic significance.
Hörl, W. (2010) · Nephrology, Dialysis and Transplantation · doi:10.1093/ndt/gfq428 · Cited by 20 · see citing works
“Routine peri-dialytic BP recordings performed by a dialysis unit staff shortly before and after the HD session are highly variable and poorly reproducible [4,5] and do not correlate well with end-organ damage [6,7].”
BackgroundBlood Pressure and Cognitive Decline in Prevalent Hemodialysis Patients
Drew, D. A., Tighiouart, H., Duncan, S., Rollins, J., Gupta, A., Scott, T. M., Weiner, D. E., & Sarnak, M. J. (2019) · American Journal of Nephrology · doi:10.1159/000500041 · Cited by 13 · see citing works
Home and Office Blood Pressure Monitoring in Renal Transplant Recipients
Sberro‐Soussan, R., Rabant, M., Snanoudj, R., Zuber, J., Bererhi, L., Mamzer, M., Legendre, C. M., & Thervet, É. (2012) · Journal of Transplantation · doi:10.1155/2012/702316 · Cited by 12 · see citing works
“Besides, one could argue that the BP threshold of home BP monitoring has not been established and is perhaps different from the general population or the patients under hemodialysis [21].”
The Dialysis Sodium Gradient: A Modifiable Risk Factor for Fluid Overload
Trinh, E., & Weber, C. L. (2017) · Nephron Extra · doi:10.1159/000453674 · Cited by 10 · see citing works
Foley, R. N., & Agarwal, R. (2007) · Seminars in Dialysis · doi:10.1111/j.1525-139x.2007.00337.x · Cited by 12 · see citing works
Self-citationAgarwal, R. (2007) · Seminars in Dialysis · doi:10.1111/j.1525-139x.2007.00314.x · Cited by 12 · see citing works
Self-citationPeripheral artery disease and blood pressure profile abnormalities in hemodialysis patients
Viazzi, F. C., Leoncini, G., Ratto, E., Storace, G., Gonnella, A., Garneri, D., Bonino, B., Cappadona, F., Parodi, E. L., Verzola, D., et al. (2016) · Journal of Nephrology · doi:10.1007/s40620-016-0322-5 · Cited by 11 · see citing works
Blood pressure targets and pharmacotherapy for hypertensive patients on hemodialysis
Maruyama, T., Takashima, H., & Abe, M. (2020) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2020.1746272 · Cited by 8 · see citing works
Uncertainties in BP management in dialysis patients
Doulton, T., Swift, P., Murtaza, A., & Dasgupta, I. (2020) · Seminars in dialysis · doi:10.1111/sdi.12880 · Cited by 8 · see citing works
Clinical significance of home blood pressure and its possible practical application
Imai, Y. (2013) · Clinical and Experimental Nephrology · doi:10.1007/s10157-013-0831-7 · Cited by 11 · see citing works
“Home BP is known to more closely reflect the usual BP of dialysis patients [152].”
BackgroundCapítulo 10 - Hipertensão na Criança e no Adolescente
Malachias, M. V. B., Souza, W., Plavnik, F. L., Rodrigues, C., Brandão, A., Neves, M. F., Bortolotto, L. A., Franco, R., Figueiredo, C., Jardim, P., et al. (2016) · Arquivos Brasileiros de Cardiologia · doi:10.5935/abc.20160160 · Cited by 9 · see citing works
Losito, A., Vecchio, L. D., Lusenti, T., Rosso, G. D., Malandra, R., Sturani, A., & Nefrologia, G. D. S. D. A. S. I. (2013) · Journal of Clinical Hypertension · doi:10.1111/jch.12074 · Cited by 9 · see citing works
“A scarce agreement between predialysis and postdialysis measurements of BP and the interdialytic ambulatory BP has been shown.(17,18) Unfortunately, so far neither ambulatory BP monitoring (APBM) or home BP measurement have been employed in large studies in dialysis patients.”
BackgroundRelationship between serum parathyroid hormone and hypertension in hemodialysis patients.
Sedighi, O., Makhlough, A., Kashi, Z., & Zahedi, M. (2011) · Iranian Journal of Kidney Diseases · Cited by 9 · see citing works
Prevalence and control of hypertension among patients on haemodialysis
Tsikliras, N., Georgianos, P., Vaios, V., Minasidis, E., Anagnostara, A., Chatzidimitriou, C., Syrganis, C., Liakopoulos, V., Zebekakis, P., & Balaskas, E. (2020) · European Journal of Clinical Investigation · doi:10.1111/eci.13292 · Cited by 11 · see citing works
Interdialytic hypertension—an update
Agarwal, R. (2011) · Advances in Chronic Kidney Disease · doi:10.1053/j.ackd.2010.10.001 · Cited by 8 · see citing works
“Advances in Chronic Kidney Disease, Vo Using ambulatory BP, only 1 in 3 dialysis patients was found to have poorly controlled hypertension, defined as day-time ambulatory BP of ,135/85 mm Hg.(8) This is in sharp contrast to 86% prevalence rates derived when only predialysis BP is taken into account.”
MethodResultInfluentialSelf-citationGlenn, T. W., Eaton, C. K., Psoter, K. J., Eakin, M. N., Pruette, C. S., Riekert, K. A., & Brady, T. M. (2022) · Pediatric Nephrology · doi:10.1007/s00467-022-05479-4 · Cited by 7 · see citing works
Perspectives on blood pressure by patients on haemo‐ and peritoneal dialysis
Evangelidis, N., Sautenet, B., Manera, K., Howell, M., Craig, J. C., Viecelli, A. K., O’Lone, E., Scholes-Robertson, N. J., Johnson, D. W., Cho, Y., et al. (2020) · Nephrology · doi:10.1111/nep.13775 · Cited by 7 · see citing works
Hypertension in Dialysis Patients: Diagnostic Approaches and Evaluation of Epidemiology
Georgianos, P., Vaios, V., Sgouropoulou, V., Eleftheriadis, T., Tsalikakis, D., & Liakopoulos, V. (2022) · Diagnostics · doi:10.3390/diagnostics12122961 · Cited by 8 · see citing works
Iatridi, F., Theodorakopoulou, M. P., Karpetas, A., Bikos, A., Karagiannidis, A. G., Alexandrou, M., Tsouchnikas, I., Mayer, C., Haidich, A., Papagianni, A., et al. (2022) · JN. Journal of Nephrology (Milano. 1992) · doi:10.1007/s40620-021-01205-9 · Cited by 7 · see citing works
“Home BP measurements display better association with interdialytic ambulatory BP [18], as well as higher prognostic ability for target-organ damage and adverse outcomes compared to peridialytic BP [12, 13], representing another reliable option for hypertension management in hemodialysis [1, 14, 19].”
BackgroundThe management of hypertension in hemodialysis and CAPD patients.
Malliara, M. (2007) · PubMed Central · Cited by 7 · see citing works
Two days ABPM-derived indices and mortality in hemodialysis patients.
Viazzi, F., Cappadona, F., Leoncini, G., Ratto, E., Gonnella, A., Bonino, B., Verzola, D., Garibotto, G., & Pontremoli, R. (2019) · American Journal of Hypertension · doi:10.1093/ajh/hpz166 · Cited by 4 · see citing works
Special Problems in Hemodialysis Patients
Goretti Penido, M. (2011) · InTech eBooks · doi:10.5772/1840 · Cited by 6 · see citing works
Doulton, T., Adam, M., Durman, K., Fan, S., Forbes, A., Jenkinson, E., Mallindine, C., McCafferty, K., Sinha, M., Stewart, D., et al. (2025) · BMC Nephrology · doi:10.1186/s12882-025-04451-2 · Cited by 7 · see citing works
- Authors
- Agarwal, R., Andersen, M. J., Bishu, K., & Saha, C.
- Affiliations
- Richard L. Roudebush VA Medical Center (US)
- Indiana University Indianapolis (US)
- Corresponding author
- Agarwal, R.
- ORCID
- Venue
- Kidney International
- Publisher
- Elsevier BV
- Published
- 2006-03
- Volume
- 69
- Issue
- 5
- Pages
- 900-906
- ISSN
- 0085-2538 (ISSN-L)
- OpenAlex
- W1963876316
- Cited by
- 175
- References
- 24
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 5 · 2023: 10 · 2022: 8 · 2021: 7 · 2020: 8 · 2019: 9 · 2018: 5 · 2017: 7 · 2016: 12 · 2015: 7 · 2014: 7 · 2013: 7 · 2012: 14
- FWCI
- 8.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Kidney International (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Dialysis Clinics
- National Institutes of Health (5t32dk062711-05)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK062030, 5T32DK062711-02)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- home blood pressure monitoring, hypertension diagnosis, hemodialysis patients, ambulatory blood pressure monitoring, systolic hypertension, isolated diastolic hypertension, blood pressure thresholds, Black patients
- MeSH terms
- Adult, Aged, Blood Pressure Determination, Female, Renal Dialysis, Humans, Hypertension, Male, Middle Aged, Sensitivity and Specificity, Blood Pressure Monitoring, Ambulatory
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