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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
BP Measurement Techniques: What They Mean for Patients with Kidney Disease
1Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio; and.
Insights
Accurate blood pressure (BP) monitoring is crucial for chronic kidney disease (CKD) patients, who often have hypertension. This review covers various BP measurement techniques, including out-of-office and central BP monitoring, essential for managing CKD complications.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Hypertension
Background:
- Hypertension is a common comorbidity in patients with chronic kidney disease (CKD).
- Traditional office-based blood pressure (BP) measurement is evolving with automated devices and out-of-office monitoring.
- CKD complicates BP assessment due to factors like masked hypertension and altered diurnal BP patterns.
Purpose of the Study:
- To review current and emerging blood pressure measurement techniques.
- To highlight the importance of specific BP monitoring strategies in patients with CKD.
- To discuss the application of these techniques in managing hypertension in CKD.
Main Methods:
- Review of existing literature on blood pressure measurement in hypertension and CKD.
- Discussion of manual, automated office, home, ambulatory, and central BP monitoring.
- Analysis of the implications of different measurement techniques for CKD patient care.
Main Results:
- Automated devices and out-of-office monitoring (home, ambulatory) offer advantages over manual BP measurement.
- Out-of-office BP monitoring is critical in CKD to detect masked hypertension and abnormal BP patterns.
- Central BP and hemodynamics measurement are increasingly relevant in CKD due to specific pathophysiological alterations.
Conclusions:
- Various BP measurement techniques are available, each with specific applications in CKD management.
- Optimizing BP measurement strategies is vital for improving outcomes in patients with CKD.
- Understanding and utilizing advanced BP monitoring can lead to better hypertension control and reduced target organ damage in CKD.
Abstract:
Patients with CKD typically have hypertension. Manual BP measurement in the office setting was used to define hypertension, establish eligibility, and assess BP targets in the epidemiologic studies and early randomized, controlled trials that inform current management of hypertension. Use of automated oscillometric devices has largely replaced manual BP measurement in the office and clinical trials. These newer devices may reduce the white coat effect and facilitate guideline-adherent measurement protocols. Obtaining BP measurements outside of the office with home and ambulatory BP monitoring is now more common. Out of office BPs are especially important in patients with CKD, because reduced GFR and proteinuria are associated with masked hypertension (normal office BP and elevated BP outside of the office), elevated nighttime BP, and abnormal diurnal variation in BP, all of which are associated with higher risk for target organ damage and adverse outcomes. Also, it is now feasible to routinely measure central BP and central hemodynamics. These measures are of greater importance to patients with CKD given the higher prevalence of increased sympathetic tone, arteriosclerosis, and inflammation as well as impaired sodium excretion and endothelial dysfunction, which lead to alterations in central BPs in this population. In this review, we describe various BP measurement techniques and how they apply to the care of patients with CKD.
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