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Accuracy of 24 h ambulatory blood pressure recordings for diagnosing high 44 h blood pressure in hemodialysis: a diagnostic test study

Hypertension Research volume 47, pages 1042–1050 (2024)Cite this article

Abstract

Hypertension is highly prevalent in hemodialysis patients. Ambulatory-BP-monitoring(ABPM) during the 44 h interdialytic interval is recommended for hypertension diagnosis and management in these subjects. This study assessed the diagnostic accuracy of fixed 24 h ABPM recordings with 44 h BP in hemodialysis patients. 242 Greek hemodialysis patients that underwent valid 48 h ABPM(Mobil-O-Graph NG device) were included in the analysis. We used 44 h BP as reference method and tested the accuracy of the following BP metrics: 1st 24 h without HD period (20 h-1st), 1st 24 h including HD period (24 h–1st) and 2nd 24 h(24 h–2nd). All studied metrics showed strong correlations with 44 h SBP/DBP (20 h–1st: r = 0.973/0.978, 24 h–1st: r = 0.964/0.972 and 24 h–2nd: r = 0.978/0.977, respectively). In Bland-Altman analysis, small between-method differences (−1.70, −1.19 and +1.45 mmHg) with good 95% limits-of agreement([−10.83 to 7.43], [−11.12 to 8.74] and [−6.33 to 9.23] mmHg, respectively) for 20 h–1st, 24 h–1st and 24 h–2nd SBP were observed. The sensitivity/specificity and κ-statistic for diagnosing 44 h SBP ≥ 130 mmHg were high for 20 h–1st SBP(87.2%/96.0%, κ-statistic = 0.817), 24 h–1st SBP(88.7%/96.0%, κ-statistic = 0.833) and 24 h–2nd SBP (95.0%/88.1%, κ-statistic = 0.837). Similar observations were made for DBP. In ROC-analyses, all studied BP metrics showed excellent performance with high Area-Under-the- Curve values (20 h–1st: 0.983/0.992; 24 h–1st: 0.984/0.987 and 24 h–2nd: 0.982/0.989 for SBP/DBP respectively). Fixed 24 h ABPM recordings during either the first or the second day of interdialytic interval have high accuracy and strong agreement with 44 h BP in hemodialysis patients. Thus, ABPM recordings of either the first or the second interdialytic day could be used for hypertension diagnosis and management in these subjects.

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Authors and Affiliations

  1. First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Marieta Theodorakopoulou, Areti Georgiou, Fotini Iatridi, Eleni Karkamani, Anastasia Stamatiou, Nikolaos Devrikis, Artemios Karagiannidis, Amalia Baroutidou & Pantelis Sarafidis

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  1. Marieta Theodorakopoulou
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Correspondence to Marieta Theodorakopoulou.

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Theodorakopoulou, M., Georgiou, A., Iatridi, F. et al. Accuracy of 24 h ambulatory blood pressure recordings for diagnosing high 44 h blood pressure in hemodialysis: a diagnostic test study. Hypertens Res 47, 1042–1050 (2024). https://doi.org/10.1038/s41440-024-01584-z

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