Nephrology Division, Hypertension Unit, University of São Paulo School of Medicine, São Paulo, Brazil.
Nephrol Dial Transplant. 2009 Dec;24(12):3805-11. doi: 10.1093/ndt/gfp332. Epub 2009 Jul 8.
It is not known if the adjustment of antihypertensive therapy based on home blood pressure monitoring (HBPM) can improve blood pressure (BP) control among haemodialysis patients.
This is an open randomized clinical trial. Hypertensive patients on haemodialysis were randomized to have the antihypertensive therapy adjusted based on predialysis BP measurements or HBPM. Before and after 6 months of follow-up, patients were submitted to ambulatory blood pressure monitoring (ABPM) for 24 h, HBPM during 1 week and echocardiogram.
A total of 34 and 31 patients completed the study in the HBPM and predialysis BP groups, respectively. At the end of study, the systolic (SBP) and diastolic (DBP) blood pressure during the interdialytic period measured by ABPM were significantly lower in the HBPM group in relation to the predialysis BP group (mean 24-h BP: 135 +/- 12 mmHg/76 +/- 7 mmHg versus 147 +/- 15 mmHg/79 +/- 8 mmHg; P < 0.05). In the HBPM analysis, the HBPM group showed a significant reduction only in SBP compared to the predialysis BP group (weekly mean: 144 +/- 21 mmHg versus 154 +/- 22 mmHg; P < 0.05). There were no differences between the HBPM and predialysis BP groups in relation to the left ventricular mass index at the end of the study (108 +/- 35 g/m(2) versus 110 +/- 33 g/m(2); P > 0.05).
Decision making based on HBPM among haemodialysis patients has led to a better BP control during the interdialytic period in comparison with predialysis BP measurements. HBPM may be a useful adjuvant instrument for blood pressure control among haemodialysis patients.
目前尚不清楚基于家庭血压监测（HBPM）调整降压治疗是否能改善血液透析患者的血压控制。
这是一项开放的随机临床试验。将接受血液透析的高血压患者随机分为两组，一组根据透析前血压测量值调整降压治疗，另一组根据 HBPM 调整降压治疗。在 6 个月的随访前后，患者接受了 24 小时动态血压监测（ABPM）、1 周 HBPM 和超声心动图检查。
共有 34 名和 31 名患者分别完成了 HBPM 和透析前 BP 组的研究。研究结束时，HBPM 组在透析间期的收缩压（SBP）和舒张压（DBP）通过 ABPM 测量明显低于透析前 BP 组（平均 24 小时 BP：135±12mmHg/76±7mmHg 比 147±15mmHg/79±8mmHg；P<0.05）。在 HBPM 分析中，HBPM 组仅与透析前 BP 组相比 SBP 有显著降低（每周平均：144±21mmHg 比 154±22mmHg；P<0.05）。研究结束时，HBPM 组和透析前 BP 组的左心室质量指数无差异（108±35g/m2 比 110±33g/m2；P>0.05）。
与透析前 BP 测量相比，基于 HBPM 的决策制定使血液透析患者的透析间期血压控制更好。HBPM 可能是血液透析患者血压控制的有用辅助工具。
