Abstract
Introductionhome blood pressure measurement (HBPM) is not entirely capable of replacing ambulatory blood pressure (BP) measurement (ABPM), but is superior to office blood pressure measurement (OBPM). Although availability, cost, energy and lack of training are potential limitations for a wide use of HBPM in Sub-Saharan Africa (SSA), the method may add value for assessing efficacy and compliance in specific populations. We assessed the agreement between HBPM and ABPM in chronic kidney disease (CKD) patients in Douala, Cameroon.Methodsfrom March to August 2014, we conducted a cross sectional study in non-dialyzed CKD patients with hypertension. Using the same devices and methods, the mean of nine office and eighteen home (during three consecutive days) blood pressure readings were recorded. Each patient similarly had a 24-hour ABPM. Kappa statistic was used to assess qualitative agreement between measurement techniques.Resultsforty-six patients (mean age: 56.2 ± 11.4 years, 28 men) were included. The prevalence of optimal blood pressure control was 26, 28 and 32% for OBPM, HBPM and ABPM respectively. Compared with ABPM, HBPM was more effective than OBPM, for the detection of non-optimal BP control (Kappa statistic: 0.49 (95% CI: 0.36 - 0.62) vs. 0.22 (95%CI: 0.21 - 0.35); sensitivity: 60 vs 40%; specificity: 87 vs. 81%).ConclusionHBPM potentially averts some proportion of BP misclassification in non-dialyzed hypertensive CKD patients in Cameroon.
Highlights
Blood pressure (BP) control has been widely highlighted as a key component in decreasing the progression of Chronic Kidney disease (CKD) [1] and reducing the overall cardiovascular risk of affected patients [2]
Our study suggests that home BP measurement (HBPM) potentially reduces white-coat hypertension in 7% of the cases (20% with office BP measurement (OBPM) vs 13% with HBPM), which is similar to findings obtained from developed countries (30% with OBPM vs 24% for HBPM) [20, 27]
Our study explored the degree of accuracy of a comparatively affordable measure (HBPM) in patients with CKD, for whom thorough BP control is a key pillar in management and prognosis
Summary
Blood pressure (BP) control has been widely highlighted as a key component in decreasing the progression of Chronic Kidney disease (CKD) [1] and reducing the overall cardiovascular risk of affected patients [2]. Owing to the relative availability and ease of use, office BP measurement (OBPM) was commonly used in the past for the assessment of BP control in patients with CKD; but over the last decade, several studies have shown that out-of-office BP measurements perform better than OBPM [3, 4], with Ambulatory BP Measurement (ABPM) recognized as the gold standard [3, 5, 6]. Evidence from developed countries has shown that HBPM is a relatively cheap, reliable and an accurate alternative for the assessment of BP control in patients with CKD [8], studies from SSA to support this are scanty. The aim of our study was to determine whether HBPM using an OMRON device provides similar results to a 24-hour ABPM recording in patients with chronic kidney disease in Cameroon
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