Treating Home Versus Predialysis Blood Pressure Among In-Center Hemodialysis Patients: A Pilot Randomized Trial.
Treating Home Versus Predialysis Blood Pressure Among In-Center Hemodialysis Patients: A Pilot Randomized Trial.
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DOI：
10.1053/j.ajkd.2020.06.014
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Hsu CY
中科院分区：
文献类型：
--
作者：
Bansal N;Glidden DV;Mehrotra R;Townsend RR;Cohen J;Linke L;Palad F;Larson H;Hsu CY
Observational studies have reported a U-shaped association between pre-dialysis blood pressure (BP) and death. In contrast, a linear association between out-of-dialysis unit BP has been reported. Home BP may be a better target for treatment. To test the feasibility of this approach, we conducted a pilot trial of treating home vs. pre-dialysis BP in hemodialysis patients. A 4-month parallel, randomized controlled trial. Fifty prevalent hemodialysis patients in San Francisco and Seattle. Participants were randomized using 1: 1 block randomization, stratified by site. Target home systolic BP (SBP) vs. pre-dialysis SBP 140-100 mmHg. Home and pre-dialysis SBPs were ascertained every 2 weeks. Dry weight and BP medications were adjusted to reach the target SBP. Primary outcomes were feasibility, adherence, safety and tolerability. Fifty out of seventy patients who were approached agreed to participate (71.4%). All enrollees completed the study except one who received a kidney transplant. In the home BP treatment group, adherence to obtaining/reporting home BP was 97.4% (and consistent over the 4 months). There was no increased frequency of high (defined as SBP>200 mmHg, 0.2% vs. 0%) or low (defined as <90 mmHg, 1.8% vs.1.2%) predialysis BP readings in the home vs. pre-dialysis treatment arms, respectively. However, participants in the home BP arm had higher frequency of fatigue (32% vs. 16%). Small sample size. This pilot trial demonstrates feasibility and high adherence to home BP measurement and treatment in hemodialysis patients. Larger trials to test long-term feasibility, efficacy and safety of home BP treatment in hemodialysis patients should be conducted. National Institutes of Health, Satellite Healthcare and Northwest Kidney Centers ClinicalTrials.gov Identifier: NCT03459807 Home blood pressure may be a better target for treatment compared with blood pressure measured at the time of dialysis in hemodialysis patients. In this pilot clinical trial, we tested the feasibility of measuring and treating home blood pressure (compared with treating blood pressure at the time of hemodialysis) over 4 months in 50 participants at two sites. The enrollment rates were high in the trial and nearly all participants completed the study. We observed high rates of adherence to home blood pressure measures and promising safety signals. In conclusion, this trial demonstrates that measurement of home blood pressure is feasible in hemodialysis patients. Larger studies are needed to test the long-term effect and safety of treating home blood pressure in hemodialysis patients.
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设置不同血压监测间隔的阈值会对人群中白大衣高血压和隐匿性高血压相关的风险估计产生不同的影响。
DOI：
10.1161/hypertensionaha.114.03614
发表时间：
2014-11
期刊：
Hypertension (Dallas, Tex. : 1979)
影响因子：
--
作者：
Asayama K;Thijs L;Li Y;Gu YM;Hara A;Liu YP;Zhang Z;Wei FF;Lujambio I;Mena LJ;Boggia J;Hansen TW;Björklund-Bodegård K;Nomura K;Ohkubo T;Jeppesen J;Torp-Pedersen C;Dolan E;Stolarz-Skrzypek K;Malyutina S;Casiglia E;Nikitin Y;Lind L;Luzardo L;Kawecka-Jaszcz K;Sandoya E;Filipovský J;Maestre GE;Wang J;Imai Y;Franklin SS;O'Brien E;Staessen JA;International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO) Investigators
通讯作者：
International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO) Investigators
影响因子：
19.6
作者：
Agarwal, R;Lewis, RR
通讯作者：
Lewis, RR
影响因子：
4.2
作者：
Agarwal, Rajiv;Andersen, Martin J.;Light, Robert P.
通讯作者：
Light, Robert P.
影响因子：
8.3
作者：
Agarwal, Rajiv;Alborzi, Pooneh;Light, Robert P.
通讯作者：
Light, Robert P.
影响因子：
--
作者：
Breidthardt, Tobias;Burton, James O.;McIntyre, Christopher W.
通讯作者：
McIntyre, Christopher W.