Role of Ambulatory Blood Pressure Monitoring in Management of Hypertension in Patients with Chronic Kidney Disease on Hemodialysis

Background: Chronic kidney disease (CKD) is strongly associated with hypertension (HTN) and each can cause or aggravate the other. Ambulatory blood pressure monitoring (ABPM) is a superior prognostic marker compared with office BP and has successfully identified hypertensive CKD patients at increased risk. ABPM provides information on circadian BP variation and short-term BP variability, which is associated with cardiovascular and renal outcomes. This review examines the role of ambulatory blood pressure monitoring in management of hypertension in patients with chronic kidney disease undergoing regular hemodialysis.

Aims and objectives: To study the role of ambulatory blood pressure monitoring in management of hypertension in patients with chronic kidney disease undergoing regular hemodialysis and to study the correlation between intradialytic blood pressure with ambulatory blood pressure monitoring.

Methods: This was an observational study of CKD patients undergoing hemodialysis with Hemodialysis vintage more than 1 month who performed ABPM in tertiary care unit. Data collected from clinical record and ABPM records.

Results: A total of 100 hypertensive CKD patients were reviewed. The correlation between intradialytic blood pressure with ambulatory blood pressure was found to be statistically significant. Pre-HD SBP correlated with 24 hour mean SBP, active period SBP and passive period SBP.

Conclusion: There was a statistically significant correlation between intradialytic blood pressure and ambulatory blood pressure. Interdialytic weight gain and cholesterol are modifiable risk factors. Pre-HD SBP and 24 hour mean SBP were independent risk factor for IDH. Patients with higher BP have higher BP burden (intradialytic and interdialytic) and may require aggressive control of BP.