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Updated: Apr 23, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Practical use of home blood pressure monitoring in chronic kidney disease
Sarah Sanghavi1, Joseph A Vassalotti2
1Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, N.Y., USA.
Insights
Home BP monitoring (HBPM) improves hypertension control in chronic kidney disease (CKD) patients by enhancing accuracy and adherence. This method aids in managing difficult-to-control blood pressure (BP) and predicting disease progression.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Management
Background:
- Hypertension remains poorly controlled in chronic kidney disease (CKD) patients despite available treatments.
- Declining glomerular filtration rate necessitates more medications, potentially reducing adherence and causing therapeutic inertia.
- Home blood pressure monitoring (HBPM) offers a solution to improve BP management in this population.
Purpose of the Study:
- To evaluate the role and effectiveness of Home Blood Pressure Monitoring (HBPM) in managing hypertension within the chronic kidney disease (CKD) population.
- To highlight HBPM's potential in improving diagnostic accuracy, patient adherence, and therapeutic intervention for hypertension in CKD.
- To discuss the adaptation of HBPM for assessing nocturnal BP patterns (nondipping and reverse dipping) relevant to CKD patients.
Main Methods:
- Utilizing Home Blood Pressure Monitoring (HBPM) with a definition of hypertension as an average BP >135/85 mm Hg.
- Collecting at least twelve readings over 3-5 days for clinical decision-making.
- Comparing HBPM's predictive value for end-stage renal disease or death against office BP monitoring.
Main Results:
- HBPM enhances diagnostic accuracy, crucial for identifying white coat or masked hypertension in CKD patients (affecting approximately half).
- Preliminary data indicate HBPM outperforms office BP monitoring in predicting CKD progression and mortality.
- Combined with support (telemonitoring, behavioral therapy), HBPM leads to sustained improvements in blood pressure control.
Conclusions:
- Home Blood Pressure Monitoring (HBPM) is a valuable tool for improving hypertension management in chronic kidney disease (CKD) patients.
- HBPM aids in accurate diagnosis, risk stratification, and enhanced patient adherence, leading to better blood pressure control.
- Further research is needed to confirm the cost-effectiveness of HBPM in the US healthcare system, especially considering its utility in assessing diurnal BP variations.
Abstract:
Despite the availability of blood pressure (BP)-lowering medications and dietary education, hypertension is still poorly controlled in the chronic kidney disease (CKD) population. As glomerular filtration rate declines, the number of medications required to achieve BP targets increases, which may lead to reduced patient adherence and therapeutic inertia by the clinician. Home BP monitoring (HBPM) has emerged as a means of improving diagnostic accuracy, risk stratification, patient adherence, and therapeutic intervention. The definition of hypertension by HBPM is an average BP >135/85 mm Hg. Twelve readings over the course of 3-5 days are sufficient for clinical decision making. Diagnostic accuracy is especially important in the CKD population as approximately half of these patients have either white coat hypertension or masked hypertension. Preliminary data suggest that HBPM outperforms office BP monitoring in predicting progression to end-stage renal disease or death. When combined with additional support such as telemonitoring, medication titration, or behavioral therapy, HBPM results in a sustained improvement in BP control. HBPM must be adapted to provide information on the phenomena of nondipping (absence of nocturnal fall in BP) and reverse dipping (paradoxical increase in BP at night). These diurnal patterns are more prevalent in the CKD population and are important cardiovascular risk factors. Ambulatory BP monitoring provides nocturnal BP readings and unlike HBPM may be reimbursed by Medicare when certain criteria are met. Further studies are needed to determine whether HBPM is cost-effective in the current US healthcare system.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.