Leonidou Kallistheni, Georgianos Panagiotis I, Kollias Anastasios, Kontogiorgos Ioannis, Vaios Vasilios, Leivaditis Konstantinos, Karligkiotis Apostolos, Stamellou Eleni, Balaskas Elias V, Stergiou George S, Liakopoulos Vassilios
2nd Department of Nephrology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, 3rd Department of Medicine, Sotiria Hospital, Athens, Greece.
J Hum Hypertens. 2025 May;39(5):355-361. doi: 10.1038/s41371-025-01007-7. Epub 2025 Mar 17.
The optimal method for the diagnosis of hypertension among patients on hemodialysis remains a controversial issue. Using 44-h ambulatory blood pressure (BP) monitoring (ABPM) as the reference-standard, we assessed the diagnostic performance of home BP monitoring (HBPM) versus routine dialysis-unit BP recordings in hemodialysis patients. Over a period of 2 weeks, the following methods were used for the assessment of hypertension: (i) routine predialysis and postdialysis BP recordings averaged over 6 consecutive dialysis sessions; (ii) HBPM for 7 days (duplicate morning and evening measurements, Microlife WatchBP Home N); (iii) 44-h ABPM (20-min intervals over an entire interdialytic interval, Microlife WatchBPO3). The study included 70 patients (mean age: 65.3 ± 13.2 years; treated hypertensives: 87.1%; 44-h ambulatory systolic/diastolic BP: 120.6 ± 15.2/66.3 ± 10.1 mmHg). Mean (standard deviation) of the differences between ambulatory daytime systolic BP (SBP) and routine predialysis SBP was -11.4 (13.4) mmHg, routine postdialysis SBP -4.0 (15.1) mmHg and home SBP -8.6 (10.7) mmHg. The area under the receiver-operating-characteristic-curve (AUC) for the detection of an ambulatory daytime SBP ≥ 135 mmHg was higher for home SBP [AUC: 0.934; 95% confidence interval (CI): 0.871-0.996] relative to predialysis SBP (AUC: 0.778; 95% CI: 0.643-0.913) and postdialysis SBP (AUC: 0.766; 95% CI: 0.623-0.909) (P = 0.02 for both comparisons). Home SBP at the cut-off point of 141.0 mmHg provided the best combination of sensitivity (85.7%) and specificity (92.9%) in diagnosing hypertension. In conclusion, the present study shows that among hemodialysis patients, HBPM for 1 week is superior to 2-week averaged routine predialysis or postdialysis BP in predicting ambulatory hypertension.
对于接受血液透析的患者，高血压的最佳诊断方法仍是一个存在争议的问题。我们以44小时动态血压监测（ABPM）作为参考标准，评估了家庭血压监测（HBPM）与血液透析患者常规透析单元血压记录在诊断方面的表现。在2周的时间里，采用以下方法评估高血压：（i）连续6次透析疗程的常规透析前和透析后血压记录的平均值；（ii）7天的HBPM（早晚重复测量，Microlife WatchBP Home N）；（iii）44小时ABPM（整个透析间期每20分钟测量一次，Microlife WatchBPO3）。该研究纳入了70名患者（平均年龄：65.3±13.2岁；接受治疗的高血压患者：87.1%；44小时动态收缩压/舒张压：120.6±15.2/66.3±10.1 mmHg）。动态日间收缩压（SBP）与常规透析前SBP之间差值的平均值（标准差）为-11.4（13.4）mmHg，常规透析后SBP为-4.0（15.1）mmHg，家庭SBP为-8.6（10.7）mmHg。对于检测动态日间SBP≥135 mmHg，家庭SBP的受试者工作特征曲线下面积（AUC）[AUC：0.934；95%置信区间（CI）：0.871 - 0.996]高于透析前SBP（AUC：0.778；95% CI：0.643 - 0.913）和透析后SBP（AUC：0.766；95% CI：0.623 - 0.909）（两项比较P均 = 0.02）。在诊断高血压时，家庭SBP在切点为141.0 mmHg时，提供了最佳的敏感性（85.7%）和特异性（92.9%）组合。总之，本研究表明，在血液透析患者中，1周的HBPM在预测动态高血压方面优于2周平均的常规透析前或透析后血压。
