Diagnosing hypertension by intradialytic blood pressure recordings

Rajiv Agarwal, Tesfamariam Metiku, Getachew G. Tegegne, Robert P. Light, Zerihun Bunaye, Dagim M. Bekele, Ken Kelley

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background and objectives: The diagnosis of hypertension among hemodialysis patients by predialysis or postdialysis blood pressure (BP) recordings is imprecise and biased and has poor test-retest reliability. The use of intradialytic BP measurements to diagnose hypertension is unknown. Design, setting, participants, & measurements: A diagnostic-test study was done with interdialytic ambulatory BP as reference standard. Index BP recordings tested were: predialysis (method 1), postdialysis (method 2), intradialytic (method 3), intradialytic including predialyis and postdialysis (method 4), and the average of predialysis and postdialysis (method 5). Each index BP was recorded over six consecutive dialysis treatments. Results: There were differences among index BP measurements in reproducibility, bias, precision, and accuracy. Method 4 was the most reproducible (intraclass correlation coefficient = 0.70 for systolic and diastolic BP). All 5 measurement methods overestimated 44-h ambulatory systolic BP. Methods 2, 3, or 4 overestimated ambulatory systolic BP by only a small amount. Method 4 was the most precise and accurate. For diagnosis of hypertension, BP cut-point by method 4 of 135/75 mmHg, had a sensitivity of 90.4% and specificity of 75.9% for systolic BP (area under ROC curve 0.90). Median cut-off systolic BP of 140 mmHg from a single dialysis provides approximately 80% sensitivity and 80% specificity in diagnosing systolic hypertension; a median cut-off diastolic BP of 80 mmHg provides approximately 75% sensitivity and 75% specificity in diagnosing diastolic hypertension. Conclusions: Consideration of intradialytic BP measurements together with predialysis and postdialysis BP measurements improves the reproducibility, bias, precision, and accuracy of BP measurement compared with predialysis or postdialysis measurements.

Original languageEnglish
Pages (from-to)1364-1372
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume3
Issue number5
DOIs
StatePublished - Sep 2008

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Blood Pressure
Hypertension
Sensitivity and Specificity
Dialysis
Routine Diagnostic Tests
Reproducibility of Results
ROC Curve
Area Under Curve
Renal Dialysis

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Agarwal, R., Metiku, T., Tegegne, G. G., Light, R. P., Bunaye, Z., Bekele, D. M., & Kelley, K. (2008). Diagnosing hypertension by intradialytic blood pressure recordings. Clinical Journal of the American Society of Nephrology, 3(5), 1364-1372. https://doi.org/10.2215/CJN.01510308

Diagnosing hypertension by intradialytic blood pressure recordings. / Agarwal, Rajiv; Metiku, Tesfamariam; Tegegne, Getachew G.; Light, Robert P.; Bunaye, Zerihun; Bekele, Dagim M.; Kelley, Ken.

In: Clinical Journal of the American Society of Nephrology, Vol. 3, No. 5, 09.2008, p. 1364-1372.

Research output: Contribution to journalArticle

Agarwal, R, Metiku, T, Tegegne, GG, Light, RP, Bunaye, Z, Bekele, DM & Kelley, K 2008, 'Diagnosing hypertension by intradialytic blood pressure recordings', Clinical Journal of the American Society of Nephrology, vol. 3, no. 5, pp. 1364-1372. https://doi.org/10.2215/CJN.01510308
Agarwal, Rajiv ; Metiku, Tesfamariam ; Tegegne, Getachew G. ; Light, Robert P. ; Bunaye, Zerihun ; Bekele, Dagim M. ; Kelley, Ken. / Diagnosing hypertension by intradialytic blood pressure recordings. In: Clinical Journal of the American Society of Nephrology. 2008 ; Vol. 3, No. 5. pp. 1364-1372.
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