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Nephrol Dial Transplant (1992) 7: 917-923
© 1992 European Renal Association-European Dialysis and Transplant Association

research-article

Blood pressure during the interdialytic period in haemodialysis patients: estimation of representative blood pressure values

J. P. Kooman1,, U. Gladziwa3, G. Böcker3, J. A. G. Wijnen2, L. v. Bortel2, A. J. Luik1, P. W. de Leeuw1, J. P. v. Hooff1 and K. M. L. Leunissen1

1Department of Internal Medicine State University Limburg Maastricht, The Netherlands, Germany 2Department of Pharmacology State University Limburg Maastricht, The Netherlands, Germany 3Dialysis Clinic Aachen Germany

Correspondence and offprint requests to: Correspondence and offprint requests to:J. P. Kooman MD, Department of Internal Medicine, University Hospital, P.O. Box 5800,6202 AZ Maastricht, The Netherlands.

The estimation of representative blood pressure (BP) levels is difficult in haemodialysis (HD) patients as it is not known whether pre- or postdialytic blood pressure are predictive for the average interdialytic BP. Furthermore, the day-night BP rhythm can be disturbed in HD patients. Therefore, in this study, BP was measured during the interdialytic period using non-invasive ambulatory BP measurements in fourhypotensive, six normotensive, and 12 hypertensiveHD patients. It was assessed whether pre- or postdia-lytic BP was representative for the average interdia-lytic BP. Furthermore, the nocturnal BP reductionwas compared between HD patients, seven normotensive controls and eight treated subjects with essential hypertension. Postdialytic BP was superior topredialytic BP in predicting the average BP duringthe interdialytic period. BP did not differ significantly between day 1 and day 2 of the interdialytic period but increased rapidly in the hours before dialysis.Weight gain (corrected for actual body-weight) did not correlate significantly with the increment in sys-tolic BP (r=0.21; P = 0.2) or diastolic BP (r = –0.02; P = 0.5) during the interdialytic period. The nocturnaldecline in systolic BP was significantly attenuated(P<0.001) in hypertensive HD patients compared with normotensive controls. The nocturnal reduction in diastolic BP was significantly less in hypotensive(P<0.001) and normotensive (P<0.001) HD patients compared with normotensive controls and in hypertensive HD patients compared with normotensive (P<0.001) and hypertensive (P<0.001) controls. We conclude that postdialytic BP is more representative for the average interdialytic BP than predialytic BP and should therefore be used to define hypertension in HD patients. BP increases rapidly in the hours before HD. Furthermore, the nocturnal reduction in BP is attenuated in HD patients, which might have consequences for the prescription of antihypertensive therapy.

Keywords: interdialytic blood pressure; haemodialysis; antihypertensive therapy


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