ABSTRACT
Since readings of blood pressure at dialysis are certainly convenient and practical, several other investigators have examined their value. Salem preferred using the predialysis blood pressure in a study of hemodialysis patients, while recognizing that is may be inflated by predialysis overhydration. He used a level of 160/90 mmHg to indicate the presence of hypertension (16). A recent study found, in fact, that predialysis blood pressure readings did correlate significantly with 24-hour ambulatory blood pressure and left ventricular hypertrophy (12). Postdialysis blood pressure ideally reflects the patient’s true dry hydration state. However, recent studies indicate that blood pressure rebounds shortly after hemodialysis treatments (9,17,18), making it clear that postdialysis blood pressure probably is not a good correlate of interdialytic hypertensive load in many patients. A study reported by Kooman et al., however, found postdialysis blood pressure actually correlated well with average interdialytic blood pressure (19). Ultimately, 24-or 48-hour ambulatory blood pressure monitoring provides the clearest picture of interdialytic hypertensive load, but the test is impractical to apply. Therefore, given the complexity of the problem and the mixed results from the literature, it is not possible to recommend a specific best practice for monitoring blood pressure control for hemodialysis patients. The predialysis, postdialysis, and interdialytic blood pressures may all be important. The clinician should attempt to maintain both pre-and postdialysis blood pressure below the target level. Occasional ambulatory monitoring could greatly enhance the understanding of the individual patient’s hypertensive load. Further research is needed to examine this issue.
