Abstract: SA-PO407
Guideline-Concordant vs. Routinely Measured Predialysis Blood Pressure (BP), and Home BP in Prevalent Hemodialysis (HD) Patients
Session Information
- Hemodialysis and Frequent Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Ukrainetz, Judy A., University of Alberta, Edmonton, Alberta, Canada
- Braam, Branko, University of Alberta, Edmonton, Alberta, Canada
Background
Pre-HD blood pressure is a pivotal vital sign in clinical decision-making. Yet, obtaining accurate measurements remains challenging. Pre-HD BP has been reported to poorly correlate with home BP. In this study, we investigated whether guideline-concordant measured pre-HD BP taken by the research team is better correlated to home BP than routine BP measurements taken by HD nurses.
Methods
Three automated and three manual BP measurements were obtained pre-HD by the research team strictly following Hypertension Canada guidelines. BP was also measured by the HD nurses as per program routines using the HD machine. Patients measured BP at home at 4 occasions. We observed and recorded whether nurses followed the 10 quality guidelines. Data are mean+sd.
Results
The 37 patients were 61+15 years of age, 49/51% female/male. HD vintage was 1 year and 7 months (2 months-8 years). Automated BP was 136/71+31/17 mmHg and manual BP was 135/69+31/17 mmHg (NS) as assessed by the research team. Routine nurse measured BPs averaged 140/63+29/19 mmHg. Pulse pressures were 60+18 by the research team, 77+26 by the nurses and 60+19 mmHg by patients at home (P<0.01, home vs. nurses). There was a significant correlation between SBP, DBP, and PP between measurements taken by the research team and nurses, but not between those and home BPs. A strong discrepancy was observed between research and nurse measurements, as assessed by the level of agreement for DBP, SBP, and PP (Bland Altman).
None of the 36 observed BP measurements by 22 nurses were fully concordant with the guidelines. The time of resting before the measurement was highly variable (0-15 minutes). None of the patients were asked whether food, drinks, or caffeine were consumed, or if people had smoked within 30 minutes prior to the measurement. No more than 1 pre-HD BP measurement was conducted in any of the cases. Nurses did not refrain from talking to patients during BP readings in 92% of the cases, which is known to potentially elevate readings by 25-40% within the first 30 sec of talking.
Conclusion
This study failed to show that not following guidelines for BP measurements could explain the previously reported discrepancy between home and pre-HD BPs, despite that guideline-concordant BP assessment in the HD unit was poor. Measuring BP accurately is essential in directing care for our HD patients.