Blood pressure measured at home deemed feasible for patients on in-center hemodialysis
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Results from a pilot trial showed taking at-home blood pressure measurements was feasible for patients receiving in-center hemodialysis, with high demonstrated adherence rates.
“Observational studies have reported that while the association of pre-dialysis [systolic blood pressure] SBP and adverse clinical outcomes is U-shaped, the association between out-of-dialysis-unit SBP and risk of mortality and CVD is linear in the same patients,” Nisha Bansal, MD, MAS, of the Kidney Research Institute at the University of Washington, and colleagues wrote. “Many opinion leaders and practicing nephrologists, however, believe that measuring and targeting out-of-dialysis unit BP measurements may not be feasible. We hypothesized that there will more widespread measuring and targeting home BP (which will lead to better long-term outcomes) if studies demonstrate that this is a practical approach.”
To assess the feasibility — as well as adherence to, safety and tolerance — of home blood pressure measurements, Bansal and colleagues randomized 50 patients to either at-home or in-center measurements before dialysis treatments. Target systolic BP was 140/100 mm/Hg and measurements were taken every 2 weeks.
Researchers found adherence to both obtaining and reporting BP was 97.4% in the home treatment group and this was consistent during the 4-month study period.
Further, while the home BP group did appear to have a higher frequency of fatigue than the in-center BP group (32% vs. 16%), researchers observed no increased frequency of high (defined as systolic BP >200 mm/Hg) or low (defined as systolic BP <90 mm/Hg) pre-dialysis readings between groups.
Bansal and colleagues added that patients preferred using text messaging to transmit home BP readings and patients were “enthusiastic” about a potential app-based home BP intervention.
“We found that measuring and treating home BP was feasible and well-tolerated,” the researchers concluded. “Further, we did not observe any strong signals to suggest any safety concerns. Our data support the notion that repeat measurements of home BP is a pragmatic way to obtain out-of-dialysis unit BP in many dialysis patients in the ‘real world.’”
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