Attended versus unattended blood pressure measurement in real-life settings in patients with chronic kidney disease

Background. Systolic Blood Pressure Intervention Trial (SPRINT) has raised interest in unattended automated office blood pressure (BP) measurement. It remains to be determined whether unattended BP measurement may yield lower values than conventional attended measurements in patients with very high cardiovascular risk, e.g. with chronic kidney disease (CKD). Objectives. The aim of the study was to investigate the differences in attended (ABP) vs unattended BP (NABP) in hospitalised patients with CKD. Material and methods. 60 patients were included (33 M, 27 F; age 65.6 +/- 14.0 years, eGFR 41.6 +/- 28.5 (5.2 - 94.4 ml/min)). BP (blood pressure) was first measured using the conventional auscultatory method by a medical staff member, and after a five-minute rest, three additional automated measurements with OMRON M10-IT were taken without the presence of medical staff. The same procedure was repeated over two consecutive days without any modification of antihypertensive treatment. Results. Mean unattended systolic blood pressure (NASBP) and unattended diastolic blood pressure (NADBP) were 143.6 and 77.9 mm Hg, respectively. The respective values of attended blood pressure (ABP) were 150.8 and 81.4 mm Hg. All ABP values were significantly higher than unattended blood pressure values (p = 0.009, p = 0.04 and p = 0.01, respectively). The differences between ABP and NA BP did not correlate with eGFR. The difference between ABP and NA BP was similar in diabetic and non-diabetic patients, as well as smokers vs non-smokers. Conclusions. Attended BP is significantly higher than unattended BP in patients with CKD regardless of eGFR. Automated BP measurement could become routine practice in patients with CKD.