Pickering_proof 17/7/07 3:40 pm Page 40
Cardiovascular Risk
Phase II enrolled an additional 18 subjects in an attempt to assess 11 and DBP as measured by the observer. However, there was no
people in each BP category. However, as isolated diastolic significant correlation among SBP and AI, pulse pressure or SBP as
hypertension is not common in dialysis patients, the highest DBP group measured by the observer.
was underpowered. All measurements were carried out using the
same procedure as in the first phase. Summary
Having successfully passed both phases of the ESH protocol, the
Blood Pressure researchers deemed the Microlife 3AC1-1PC oscillometric home BP
The researchers determined the mean of the observer blood pressure monitor to accurately measure BP in ESRD patients. This was despite a
measurements: mean entry SBP was 137.3±21.3mmHg (range tendency to overestimate DBP, a tendency that increased as arterial
stiffness rose and DBP fell. However, where previous studies have
underestimated DBP, the Microlife device in this study appeared to
End-stage renal disease patients
overestimate it. Whether this was due to differences in the study
populations and/or the different oscillometric device is hard to tell.
commonly suffer from increased
Nevertheless, the overall effect was similar in all ESRD patients.
arterial stiffness, which – as in
Furthermore, in contrast to previous studies where underestimation of
DBP has been lower in subjects with stiffer arteries or with diabetes, in
other populations – could affect
this study there was a greater overestimation of DBP in line with
the accuracy of oscillometric
increased arterial stiffness.
blood pressure devices used by
For SBP, the relationship between oscillometric and mercury
these patients. measurements is more variable in the literature. This study simply
found no relationship between SBP difference and either pulse
pressure or AI.
102–177mmHg) and DBP was 73.6±13.3mmHg (range 51–101mmHg).
Next, they calculated the difference between measurements taken with
the test device and the sphygmomanometer for each subject (device
Having successfully passed both
minus observer). The differences were categorised as falling within 5, 10
phases of the European Society of
or 15mmHg. In order to pass the first phase, at least 25 differences had
to be within 5mmHg, 35 within 10mmHg and at least 40 out of the 45 Hypertension protocol, the researchers
total within 15mmHg.
deemed the Microlife 3AC1-1PC
The researchers found that all of the differences fell within the
oscillometric home blood pressure
required cut-offs to pass this first phase. The measurements also fell
(BP) monitor to accurately measure
within the additional criteria needed to pass phase II.
BP in end-stage renal disease patients.
Augmentation Index
Out of the total, only 28 subjects in the trial had augmentation index
(AI) readings with a quality index greater than 80%. The AIs ranged In conclusion, this study shows the validation of an oscillometric home
from -8 to 42. Comparing the DBP difference with the AI and pulse BP monitor against the gold standard in an ESRD population. Arterial
pressure, the researchers found that both displayed a positive stiffness tends to lead to overestimations of DBP by the device. ■
correlation. Essentially, for every one unit increase in AI or pulse
pressure, the DBP difference also increased: by 0.2 and 0.12mmHg, This is a summary of a full paper published in Blood Pressure Monitoring.
9
respectively. There was a negative correlation between DBP difference Please refer to this paper for further results and discussion.
1. Agarwal R, Peixoto A, Santos S, et al., Pre-and Post Dialysis of High Blood Pressure. National Heart, Lung, and Blood Monitoring. European Society of Hypertension
blood Pressures are Imprecise Estimates of Interdialytic Institute; National High Blood Pressure Education Program recommendations for conventional, ambulatory
Ambulatory Blood, Clin J Am Soc Nephrol, 2006;1:389–98. Coordinating Committee. Seventh report of the Joint National and home blood pressure measurement, J Hypertens,
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health volunteers and insulin-dependent diabetic patients, 6. Pickering TG, Hall JE, Appel LJ, et al., Subcommittee of Hypertension. Working Group on Blood Pressure Monitoring of
J Hypertens, 1998;16(8):1125–30. Professional and Public Education of the American Heart the European Society of Hypertension International Protocol for
3. Ni H, Wu C, Prineas R, et al., Comparison of Dinamap PRO-100 Association Council on High Blood Pressure Research. validation of blood pressure measuring devices in adults, Blood
and mercury sphygmomanometer blood pressure measurements Recommendations for blood pressure measurement in Press Monit, 2002;7(1):3–17.
in a population-based study, Am J Hypertens, 2006;19(4): humans and experimental animals: Part 1: blood pressure 9. Thompson AM, Eguchi K, Reznik ME, et al., The effect of
353–60. measurement in humans: a statement for professionals arterial stiffness on the accuracy of an oscillometric home blood
4. van Popele NM, Bos WJ, de Beer NA, et al., Arterial stiffness as from the Subcommittee of Professional and Public pressure monitor in end-stage renal disease patients, Blood
underlying mechanism of disagreement between an Education of the American Heart Association Council Press Monit, 2007, in press.
oscillometric blood pressure monitor and a on High Blood Pressure Research, Hypertension, 10. Guérin AP, Pannier B, Marchais SJ, London GM, Cardiovascular
sphygmomanometer, Hypertension, 2000;36(4):484–8. 2005;45(1):142–61. disease in the dialysis population: prognostic significance of
5. Chobanian AV, Bakris GL, Black HR, et al., Joint National 7. O’Brien E, Asmar R, Beilin L, et al., European Society arterial disorders, Curr Opin Nephrol Hypertens, 2006;15(2):
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40 EUROPEAN RENAL DISEASE 2007
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