Leonidou Kallistheni, Kontogiorgos Ioannis, Kourtidou Christodoula, Georgianou Eleni, Rafailidis Vasileios, Roumeliotis Stefanos, Leivaditis Konstantinos, Balaskas Elias V, Liakopoulos Vassilios, Georgianos Panagiotis I
2nd Department of Nephrology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, GR54636 Thessaloniki, Greece.
Department of Radiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, GR54636 Thessaloniki, Greece.
Life (Basel). 2025 Aug 14;15(8):1290. doi: 10.3390/life15081290.
For patients on hemodialysis, routine blood pressure (BP) measurements taken shortly before or after dialysis provide inaccurate estimates of the BP load during the interdialytic period. In this study, we used peridialytic recordings in combination with interdialytic ambulatory BP monitoring (ABPM) aiming to provide a more precise assessment of hypertension in a sample of 70 stable hemodialysis patients. The evaluation of hypertension in the study cohort was performed using the following approaches: (i) routine predialysis and postdialysis BP measurements taken by the dialysis-unit staff were prospectively recorded over six consecutive dialysis sessions; (ii) ABPM was performed using the Microlife WatchBPO3 device (20 min intervals during an entire 44 h interdialytic period). The diagnostic thresholds of hypertension were ≥140/90 mmHg for predialysis, ≥130/80 mmHg for postdialysis and ≥130/80 mmHg for 44 h ambulatory BP, respectively. Patients receiving ≥1 antihypertensive medication also were classified as hypertensives. The prevalence of hypertension was 88.6% by predialysis, 92.9% by postdialysis and 90.0% by ambulatory BP measurements. In all, 87.1% of patients were being treated for hypertension. When the combination of predialysis and 44 h ambulatory BP was evaluated, the prevalence of sustained normotension, white-coat, masked and sustained hypertension was 52.9%, 21.4%, 5.7% and 20.0%, respectively. A similar distribution of patients into these phenotypes was observed when postdialysis BP was used for the classification of the severity of hypertension (50.0%, 24.3%, 5.7% and 20.0% for sustained normotension, white-coat, masked and sustained hypertension, respectively). Interdialytic ABPM revealed that just one patient had abnormal BP solely during the daytime period. Conversely, isolated nocturnal hypertension was diagnosed in 27.1% of patients. This study shows that among patients on hemodialysis, peridialytic BP is an inaccurate proxy of interdialytic ambulatory BP. In approximately 30% of patients, there is discordance between routine peridialytic recordings and interdialytic ABPM for the diagnosis of hypertension. ABPM also facilitates the diagnosis of isolated nocturnal hypertension, which is another frequent BP phenotype in this high-risk patient population.
对于接受血液透析的患者，在透析前不久或透析后不久进行的常规血压（BP）测量，无法准确估计透析间期的血压负荷。在本研究中，我们将透析期间的记录与透析间期动态血压监测（ABPM）相结合，旨在对70例稳定的血液透析患者样本中的高血压情况进行更精确的评估。对研究队列中的高血压评估采用以下方法：（i）由透析单元工作人员在前瞻性记录的连续6次透析过程中，测量并记录常规透析前和透析后的血压；（ii）使用Microlife WatchBPO3设备进行ABPM（在整个44小时的透析间期内，每隔20分钟测量一次）。高血压的诊断阈值分别为：透析前≥140/90 mmHg，透析后≥130/80 mmHg，44小时动态血压≥130/80 mmHg。正在接受≥1种抗高血压药物治疗的患者也被归类为高血压患者。透析前高血压患病率为88.6%，透析后为92.9%，动态血压测量为90.0%。总体而言，87.1%的患者正在接受高血压治疗。当评估透析前血压和44小时动态血压的组合时，持续性血压正常、白大衣性高血压、隐匿性高血压和持续性高血压的患病率分别为52.9%、21.4%、5.7%和20.0%。当使用透析后血压对高血压严重程度进行分类时，观察到患者在这些表型中的分布相似（持续性血压正常、白大衣性高血压、隐匿性高血压和持续性高血压分别为50.0%、24.3%、5.7%和20.0%）。透析间期ABPM显示，只有1例患者仅在白天期间血压异常。相反，27.1%的患者被诊断为单纯夜间高血压。本研究表明，在血液透析患者中，透析期间血压并不能准确代表透析间期动态血压。在大约30%的患者中，常规透析期间记录与透析间期ABPM在高血压诊断方面存在不一致。ABPM还有助于诊断单纯夜间高血压，这是该高危患者群体中另一种常见的血压表型。
