Prediction of hypertension in chronic hemodialysis patients

Rajiv Agarwal, R. R. Lewis

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Background. There are no universally accepted criteria for the diagnosis of hypertension in hemodialysis (HD) patients. We sought to determine the clinical performance of predialysis and postdialysis systolic and diastolic blood pressure values (BPs) in diagnosing hypertension or assessing its control. Methods. Seventy patients [77% African American, 46% females, mean age 59 ± 17 (SD) years, 34% diabetics] on chronic HD underwent a single 44-hour interdialytic ambulatory blood pressure monitoring (ABPM) and concomitant recording of BP by conventional syphygmomanometer in the HD unit for two weeks. Hypertension was defined as systolic BP (SBP) ≥135 mm Hg or diastolic BP (DBP) ≥ 85 mm Hg on an average 44-hour ABPM. Results. Average ABP was 144 ± 22/81 ± 11 mm Hg. Seventy-three percent of the patients had systolic hypertension; 40% had diastolic hypertension, and 24% were normotensive or had well-controlled BP. Area under the curve of receiver operating characteristic (ROC) curves exceeded 80% for all BPs, but the thresholds for best sensitivity and specificity were markedly different for predialysis and postdialysis BPs. A two-week averaged predialysis BP of >150/85 mm Hg or a postdialysis BP of >130/75 mm Hg had at least 80% sensitivity in diagnosing hypertension. Specificity of at least 80% was achieved if predialysis BP of >160/90 mm Hg or postdialysis BP of >140/80 mm Hg was used. There was poor agreement between HD unit BP and ABP values. Conclusions. HD unit BP values can be used to identify the presence or absence of hypertension, although prediction of ambulatory BPs from HD unit BP values cannot be made reliably in individual patients.

Original languageEnglish
Pages (from-to)1982-1989
Number of pages8
JournalKidney International
Volume60
Issue number5
DOIs
StatePublished - 2001

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Renal Dialysis
Hypertension
Ambulatory Blood Pressure Monitoring
Blood Pressure
ROC Curve
African Americans
Area Under Curve
Sensitivity and Specificity

Keywords

  • Ambulatory blood pressure monitoring
  • Cardiovascular death
  • Dialysis
  • Diastolic blood pressure
  • Risk factors in HD
  • Systolic blood pressure

ASJC Scopus subject areas

  • Nephrology

Cite this

Prediction of hypertension in chronic hemodialysis patients. / Agarwal, Rajiv; Lewis, R. R.

In: Kidney International, Vol. 60, No. 5, 2001, p. 1982-1989.

Research output: Contribution to journalArticle

Agarwal, Rajiv ; Lewis, R. R. / Prediction of hypertension in chronic hemodialysis patients. In: Kidney International. 2001 ; Vol. 60, No. 5. pp. 1982-1989.
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AB - Background. There are no universally accepted criteria for the diagnosis of hypertension in hemodialysis (HD) patients. We sought to determine the clinical performance of predialysis and postdialysis systolic and diastolic blood pressure values (BPs) in diagnosing hypertension or assessing its control. Methods. Seventy patients [77% African American, 46% females, mean age 59 ± 17 (SD) years, 34% diabetics] on chronic HD underwent a single 44-hour interdialytic ambulatory blood pressure monitoring (ABPM) and concomitant recording of BP by conventional syphygmomanometer in the HD unit for two weeks. Hypertension was defined as systolic BP (SBP) ≥135 mm Hg or diastolic BP (DBP) ≥ 85 mm Hg on an average 44-hour ABPM. Results. Average ABP was 144 ± 22/81 ± 11 mm Hg. Seventy-three percent of the patients had systolic hypertension; 40% had diastolic hypertension, and 24% were normotensive or had well-controlled BP. Area under the curve of receiver operating characteristic (ROC) curves exceeded 80% for all BPs, but the thresholds for best sensitivity and specificity were markedly different for predialysis and postdialysis BPs. A two-week averaged predialysis BP of >150/85 mm Hg or a postdialysis BP of >130/75 mm Hg had at least 80% sensitivity in diagnosing hypertension. Specificity of at least 80% was achieved if predialysis BP of >160/90 mm Hg or postdialysis BP of >140/80 mm Hg was used. There was poor agreement between HD unit BP and ABP values. Conclusions. HD unit BP values can be used to identify the presence or absence of hypertension, although prediction of ambulatory BPs from HD unit BP values cannot be made reliably in individual patients.

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KW - Systolic blood pressure

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