Is an average of routine postdialysis blood pressure a good indicator of blood pressure control and cardiovascular risk?

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Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension

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Published on: June 6, 2025

Philip R Harvey¹, Ashley Holt, Johann Nicholas

¹Department of Medicine, Sandwell and West Birmingham Hospitals NHS Trust, West Midlands, UK.

Journal of Nephrology

|April 17, 2012

Insights

In haemodialysis patients, post-dialysis blood pressure is a key indicator for assessing long-term blood pressure control and cardiovascular risk, particularly when other monitoring methods are unavailable.

Area of Science:

Nephrology
Cardiology
Hypertension Management

Background:

Hypertension is linked to left ventricular hypertrophy (LVH), a risk factor for mortality in haemodialysis (HD) patients.
NKF-KDOQI guidelines set pre-HD BP targets <140/90 mmHg and post-HD <130/80 mmHg.
LVH is a significant concern in the HD population, necessitating effective monitoring strategies.

Purpose of the Study:

To evaluate the correlation between 3-month mean in-unit blood pressure (BP) measurements (pre- and post-HD) and left ventricular mass index (LVMI).
To assess the utility of in-unit BP readings for long-term BP control assessment in HD patients.
To determine if post-HD BP measurements can serve as a surrogate for ambulatory or home BP monitoring.

Main Methods:

A cohort of 100 haemodialysis patients with available echocardiograms and no exclusion criteria (e.g., coronary artery disease, valvular disease) were analyzed.
Three-month mean in-unit pre- and post-dialysis BP data were collected.
Left ventricular mass index (LVMI) was measured via echocardiography to assess left ventricular hypertrophy.

Main Results:

Mean pre-HD BP was 147/77 mmHg and post-HD BP was 133/71 mmHg; less than 50% met NKF-KDOQI targets.
88% of patients exhibited LVH, with a mean LVMI of 203.7 g/m².
Post-HD mean arterial pressure (MAP) showed a significant correlation with LVMI (p=0.000047, r=0.395) on stepwise multiple regression analysis.

Conclusions:

In-unit post-HD BP measurements provide valuable insights into long-term BP control in haemodialysis patients.
Post-HD MAP is a significant predictor of LVMI, indicating cardiovascular risk.
These findings support the use of in-unit post-HD BP for risk assessment when routine ambulatory or home BP monitoring is not feasible.

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Abstract

Introduction:

Hypertension is associated with left ventricular hypertrophy (LVH), a predictor of cardiovascular mortality in haemodialysis (HD) patients. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) blood pressure (BP) targets are pre-HD <140/90 mm Hg, post-HD <130/80 mm Hg. This study aims to assess 3-month mean in-unit BP, pre- and post-HD, for correlations with left ventricular mass index (LVMI), a measure of long-term BP control.

Methods:

Of 648 HD patients, including those on HD >6 months, 262 had echocardiograms. Those with significant coronary artery disease, reduced ejection fraction or valvular disease were excluded, as were those without appropriate echocardiogram, leaving 100 patients. Data on BP and confounding factors for LVH were collected covering 3 months prior to echocardiogram.

Results:

Mean BP pre-HD was 147/77 ± 19/13 mm Hg, and post-HD, 133/71 ± 20/11 mm Hg; <50% of patients achieved NKF targets. Mean LVMI was 203.7 ± 74 g/m(2); 88% of patients had LVH. On univariate analysis, mean pre- and post-HD systolic BP, mean arterial blood pressure (MAP) and post-HD diastolic and pulse pressure correlated with LVMI. On stepwise multiple regression analysis only post-HD MAP correlated with LVMI (p=0.000047, r=0.395).

Conclusions:

We conclude that long-term averages of in-unit post-HD BP measurements are useful in assessing BP control and cardiovascular risk, especially in the absence of routine ambulatory or home BP monitoring.

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