Average Daily Blood Pressure Research Articles

Rapamycin Exacerbates Cardiovascular Dysfunction after Complete High-Thoracic Spinal Cord Injury.

Autonomic dysreflexia (AD) is a potentially life-threatening syndrome in individuals with spinal cord injury (SCI) above the T6 spinal level that is characterized by episodic hypertension in response to noxious stimuli below the lesion. Maladaptive intraspinal plasticity is thought to contribute to the temporal development of AD, and experimental approaches that reduce such plasticity mitigate the severity of AD. The mammalian target of rapamycin (mTOR) has gained interest as a mediator of plasticity, regeneration, and nociceptor hypersensitivity in the injured spinal cord. Based on our preliminary data that prolonged rapamycin (RAP) treatment markedly reduces mTOR activity in the cord weeks after high-thoracic (T4) spinal transection, we sought to determine whether RAP could modulate AD development by impeding intraspinal plasticity. Naïve and injured rats were administered RAP or vehicle every other day, beginning immediately after injury for four weeks, and hemodynamic monitoring was conducted to analyze the frequency of spontaneously occurring AD, as well as the severity of colorectal distention (CRD) induced AD. Results showed that after SCI, RAP significantly exacerbated sustained body weight loss and caused a marked elevation in resting blood pressure, with average daily blood pressure rising above even normal naïve levels within one week after injury. Moreover, RAP significantly increased the frequency of daily spontaneous AD and increased the absolute blood pressure induced by CRD at three weeks post-injury. These dynamic cardiovascular effects were not, however, correlated with changes in the density of nociceptive c-fibers or c-Fos+ neurons throughout the spinal cord, indicating that intraspinal plasticity associated with AD was not altered by treatment. These findings caution against the use of RAP as a therapeutic intervention for SCI because it evokes toxic weight loss and exacerbates cardiovascular dysfunction perhaps mediated by increased peripheral nociceptor sensitivity and/or vascular resistance.

CPAP-THERAPY IS A PROTECTIVE CARDIOVASCULAR FACTOR IN PATIENTS WITH SEVERE OBSTRUCTIVE SLEEP APNEA SYNDROME

Objective. To analyze the state of the cardiovascular system in middle-aged patients with severe obstructive sleep apnea syndrome (OSAS), before and 6 months after the use of CPAP therapy. design and methods. The study involved 35 hypertensive patients with verified severe OSAS. All patients underwent comprehensive cardiovascular assessment (blood pressure (BP) and electrocardiogram monitoring, echocardiography), CPAP therapy has been recommended as the primary treatment of obstructive sleep-disordered breathing. After 6 months, all patients underwent a complete re-examination. Patients were divided into 2 groups: the experimental group consisted of 17 people (16 men and 1 woman, mean age 49,6 ± 10,1 years) treated with CPAP therapy throughout the study period, the control group included 18 patients, who refused CPAP-therapy. Results. After 6 months of CPAP therapy, patients with severe OSAS demonstrated favourable changes in the cardiovascular system: reduction of office and average daily BP, reduced BP variability, normalization of BP circadian profile and velocity of morning BP rise. BP reduction in CPAP-users was associated with the decrease of myocardial afterload. As a result, we have witnessed a reverse myocardial remodeling, manifested by a decrease in size of both left and right heart, which also contributed to the increase in exercise tolerance and improvement of quality of life. In CPAP use was associated with the tendency to the decrease in cardiac arrhythmias. conclusions. Six-month CPAP therapy in highly compliant patients leads to the BP reduction and normalization of BP daily profile, reduction in the number of antihypertensive drugs, as well as — to a reverse myocardial remodeling.

The relationship between psychological parameters, vegetative regulation and average daily blood pressure in arterial hypertension with asthenoneurotic disorders in the marine specialists of the Arctic

The relationship between psychological parameters, vegetative regulation and average daily blood pressure in arterial hypertension with asthenoneurotic disorders in the marine specialists of the Arctic

CLINICAL EVALUATION OF THE INSULIN RESISTANCE SYNDROME IN HYPERTENSIVE PATIENTS WITH NORMAL BODY WEIGHT

Objective. To evaluate the effect of insulin resistance on arterial hypertension and target organ damage in patients with normal body weight. design and methods. The study involved 95 patients with arterial hypertension 1–2 degree (essential hypertension stage I–II) with normal body weight (body mass index 18,5– 24,9 kg/m 2) aged 30–50 years. The examination included fasting blood glucose, immunoreactive insulin, the index of insulin resistance — QUICKI factor, as well as lipids, serum uric acid and microalbuminuria. In addition, patients underwent ambulatory blood pressure monitoring, duplex scanning of neck vessels, echocardiography, endothelial function assessment. Results. The rate of insulin resistance-hyperinsulinaemia syndrome was 36 % in the studied group of hypertensive patients with normal body weight. Hypertensive patients with insulin resistance had higher average daily systolic blood pressure, higher rate and more severe target organ damage (left ventricular hypertrophy, endothelial dysfunction, intima media thickness). Among metabolic disorders, dyslipidemia was predominant, in particular, hypertriglyceridemia, as well as increased total cholesterol and LDL-cholesterol, and decrease in HDL-cholesterol. conclusions. Insulin resistance and hyperinsulinaemia syndrome is registered in 36 % of hypertensive patients with normal body weight. They are characterized by high rate of hypertension and more severe target organ damage, and metabolic disorders (mainly hypertriglyceridemia).

White coat hypertension in pediatrics.

The article summarizes current information on blood pressure changes in children during clinic visit. White coat as a general dressing of physicians and health care personnel has been widely accepted at the end of the 19th century. Two problems can be associated with the use of white coat: white coat phenomenon and white coat hypertension. Children often attribute pain and other unpleasant experience to the white coat and refuse afterwards cooperation with examinations. Definition of white coat hypertension in the literature is not uniform. It has been defined as elevated blood pressure in the hospital or clinic with normal blood pressure at home measured during the day by ambulatory blood pressure monitoring system. White coat effect is defined as temporary increase in blood pressure before and during visit in the clinic, regardless what the average daily ambulatory blood pressure values are. Clinical importance of white coat hypertension is mainly because of higher risk for cardiovascular accidents that are dependent on end organ damage (heart, vessels, kidney). Current data do not allow any clear recommendations for the treatment. Pharmacological therapy is usually started in the presence of hypertrophic left ventricle, changes in intimal/medial wall thickness of carotic arteries, microalbuminuria and other cardiovascular risk factors. Nonpharmacological therapy is less controversial and certainly more appropriate. Patients have to change their life style, need to eliminate as much cardiovascular risk factors as possible and sustain a regular blood pressure monitoring.

RENAL DENERVATION IN THE TREATMENT OF RESISTANT HYPERTENSION: RESULTS OF A ONE-YEAR OBSERVATIONAL STUDY

Aim. To study the effect of renal denervation on blood pressure (BP), myocardium function and vegetative status in patients with resistant hypertension (HT). Material and methods. Patients with a provisional resistant HT diagnosis (n=62; 41.3% male) were included into the study. 17 patients were selected for renal denervation after correction of previous antihypertensive therapy and examination to exclude symptomatic HT. Two patients refused the procedure, 1 patient hadn’t undergone renal denervation due to anatomical features (renal artery diameter <4 mm). Renal denervation was performed in 14 patients. Office and average daily BP, kidney function, the severity of left ventricular hypertrophy and heart rate variability were assessed initially and after the intervention. Results. Office systolic BP (SBP) decreased from 165 to 150 mm Hg (p=0.016), diastolic BP (DBP) - from 110 to 95 mm Hg (p=0.019) 12 months after the renal denervation. Average daily SBP decreased from 148 to 137 mm Hg (p=0.092), average daily DBP - from 90 to 80 mm Hg (p=0.401). Plasma creatinine level and glomerular filtration rate remained within the reference range at a baseline and in 12 months. Left ventricular hypertrophy measured by echocardiography has not changed significantly. No significant heart rate variability dynamics has been found. Conclusion. Renal denervation is a promising treatment for resistant HT. The effect of renal denervation on the dynamics of left ventricular hypertrophy and heart rate variability requires updating.

Ефективність ниркової денервації в пацієнтів із резистентною гіпертензією з використанням сертифікованого обладнання (результати однорічного спостереження)

Завершені контрольовані дослідження показали безпеку, але різну ефективність ниркової денервації (НДН) у хворих із резистентною артеріальною гіпертензією (АГ). Нами проведено НДН у 8 пацієнтів. Середній вік хворих становив 52,13 ± 3,88 року (40–66), середня тривалість АГ — 16,75 ± 2,17 (12–25) року. При надходженні в клініку інституту рівень артеріального тиску (АТ) становив 181,25/106,88 ± 4,3/4,0 мм рт.ст. (160–200/85–120 мм рт.ст.), ЧСС — 70,63 ± 3,03 уд/хв. Оптимізація терапії в умовах стаціонару у цих хворих привела до достовірного зниження рівня АТ до 156,88/95,00 ± 2,98 мм рт.ст. (150–165/85–100 мм рт.ст.) та ЧСС — 68,88 ± 3,28 уд/хв. Число антигіпертензивних препаратів становило в середньому 5,5 на пацієнта. При добовому моніторуванні артеріального тиску (ДМАТ) на етапі оптимізації терапії середньодобовий систолічний АТ (САТ24) становив 149,16 ± 5,40 мм рт.ст., а діастолічний (ДАТ24) — 86,98 ± 5,08 мм рт.ст. Середньодобова частота серцевих скорочень (ЧСС24) була 70,12 ± 2,94 уд/хв. Усі пацієнти добре перенесли процедуру. Середнє зниження середньодобового АТ (САТ/ДАТ) становило в динаміці на етапі 7 днів, 1, 6 та 12 місяців відповідно –15,73/–8,52 мм рт.ст., –11,45/–6,06 мм рт.ст., –10,70/–13,68 мм рт.ст. та –17,91/–13,88 мм рт.ст. Величина ЧСС24 достовірно не змінилася. Зниження денних САТ/ДАТ становило в динаміці на етапах 7 днів, 1, 6 та 12 місяців –14,79/–5,64, –16,55/–5,60, –12,29/–12,79 та –20,45/–13,62 мм рт.ст. відповідно. Динаміка зниження нічних САТ/ДАТ становила на етапах 7 днів, 1 місяць, 6 місяців та 12 місяців –15,03/–8,42, –10,64/–4,57, –9,23/–12,38 та –19,39/–14,84 мм рт.ст. відповідно. При САТ24 ≥ 160 мм рт.ст. через 12 місяців після НДН спостерігалося найбільш значне зниження середньодобового АТ –30,5/–18,9 мм рт.ст. При САТ24 ≥ 140 мм рт.ст. та < 160 мм рт.ст. через 12 місяців після процедури зниження САТ24/ДАТ24 становило –20,1/–18,0 мм рт.ст. При САТ24 < 140 мм рт.ст. достовірних змін у зниженні АТ не було. Середнє зниження офісного АТ становило в динаміці на етапах 7 днів, 1, 6 та 12 місяців відповідно –14,38/–5,63 мм рт.ст.,–9,02/–10,71 мм рт.ст., +3,12/–8 мм рт.ст. та –7,88/–5,0 мм рт.ст. Офісна ЧСС не змінилася.Розрахунковий рівень кліренсу креатиніну, визначений за формулою Кокрофта — Гаулта, достовірно не змінився в жодного пацієнта. Таким чином, застосування процедури НДН у пацієнтів із резистентною АГ є безпечним та рекомендоване лише в пацієнтів, у яких САТ за даними ДМАТ 140 мм рт.ст. і вище. Рекомендоване обов’язкове використання ДМАТ для відбору та ефективного контролю після НДН.

Вплив добового ритму артеріального тиску, прозапальних і метаболічних факторів серцево-судинного ризику на розвиток гіпертензивної нефропатії у хворих на гіпертонічну хворобу

Із метою визначення взаємозв’язку функціонального стану нирок із добовим профілем артеріального тиску (АТ), показниками вуглеводного та ліпідного обміну у хворих на гіпертонічну хворобу (ГХ) були обстежені 98 хворих на ГХ II–III стадії, 1–2-го ступеня.Усім пацієнтам проводили офісне вимірювання та добове моніторування АТ. Визначали вміст ліпідів, сечової кислоти та рівень С-реактивного протеїну (СРП) у плазмі крові, а також швидкість клубочкової фільтрації (ШКФ) за кліренсом ендогенного креатиніну та мікроальбумінурію.Установлено, що у хворих на ГХ погіршення функціонального стану нирок асоціюється з порушенням добового ритму АТ за типом non dipper, збільшенням варіабельності систолічного АТ (САТ) за добу, хронічним гемодинамічним перенавантаженням протягом доби: найбільш тісний кореляційний зв’язок ШКФ установлено з середньонічними значеннями САТ за всі періоди доби та з середньодобовим діастолічним АТ (r = –0,384, p < 0,001). У хворих на ГХ виявлено достовірну обернену кореляцію ШКФ з індексом НОМА (r = –0,417; р < 0,001), умістом інсуліну й глюкози в плазмі крові натще (r = –0,248, р < 0,05; r = –0,397, р < 0,001 відповідно) та рівнем інсуліну на 60-й хвилині глюкозотолерантного тесту (r = –0,308; р < 0,001). За допомогою багатофакторного регресійного аналізу встановлено, що факторами, пов’язаними незалежно від рівня АТ зі зниженою ШКФ у хворих на ГХ, є СРП (β = –0,285, р < 0,01), загальний холестерин (β = –0,249, р < 0,03), мікроальбумінурія (β = –0,242, р < 0,05) та індекс НОМА (β = –0,238, р < 0,05).Підвищення рівнів сечової кислоти, тригліцеридів та СРП у плазмі крові у хворих на ГХ пов’язано з поглибленням проявів гіпертензивної нефропатії (зниження ШКФ та підвищення рівня мікроальбумінурії).Гіпертензивна нефропатія у хворих на гіпертонічну хворобу асоціюється з порушеннями ліпідного обміну — підвищенням у плазмі крові рівнів загального холестерину, ліпопротеїдів низької щільності та тригліцеридів.

Порівняння значення офісного, середньодобового та центрального артеріального тиску у формуванні ураження органів-мішеней

Останнім часом з’являється все більше досліджень, що доводять більший вплив на прогноз саме центрального, а не периферичного артеріального тиску (АТ). Проте досліджень, у яких би проводили пряме порівняння значення центрального, периферичного офісного та амбулаторного АТ, проведено мало. Мета. Оцінити наявність та ступінь взаємозв’язку центрального, офісного та добового артеріального тиску з показниками ураження органів-мішеней.

Порівняльний аналіз ефективності комбінованого антигіпертензивного лікування учасників ліквідації наслідків чорнобильської аварії, хворих на гіпертонічну хворобу

It was shown the results of comparative evaluation of combined treatment in 111 clean-up workers of Chernobyl accident with essential hypertension (EH). This treatment consist of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers in combination with calcium channel blockers and diuretics. The follow-up period lasted 12 months. It was found that combined therapy provides comparable and reliable blood pressure (BP) control during 24-hour, significant reduction of average daily BP, daytime and nighttime BP, an index of time of the BP, BP variability. Despite on achieved target blood pressure level, 4 weeks treatment is not enough for regression of left ventricular hypertrophy (LVH). Significant regress of LVH was found if treatment lasted during a year under the condition that BP remained at the target level. It was revealed the advantage of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers intake combined with a diuretic on regress of left ventricular hypertrophy and dysfunction.

Letter by Castilla-Guerra and Fernandez-Moreno Regarding Article, “Average Daily Blood Pressure, Not Office Blood Pressure, Is Associated With Progression of Cerebrovascular Disease and Cognitive Decline in Older People”

To the Editor: We have read with interest the article by White et al1 recently published in Circulation . Although we consider it particularly interesting, we would like to raise 3 important issues. First, the title of the article states that average daily blood pressure (BP), not office BP, is associated with progression of cerebrovascular disease and cognitive decline in older people. However, the conclusions are not exactly the same. Authors conclude by emphasizing the importance of only 24-hour systolic …

Response to Letters Regarding Article, “Average Daily Blood Pressure, Not Office Blood Pressure, Is Associated With Progression of Cerebrovascular Disease and Cognitive Decline in Older People”

The issue of diastolic blood pressure (BP) effects is a valid one, as noted by Drs Castilla-Guerra and Fernandez-Moreno. Because systolic BP has typically been recognized as the BP parameter of interest (and cardiovascular risk) in older patients, we chose to focus on systolic measures in our study. Analyses of changes in diastolic BP relative to the white matter hyperintensity (WMH) lesions and 2 of the cognitive parameters at 24 months of follow-up did demonstrate significant relationships for 24-hour, awake, and sleep diastolic BP, but the clinic diastolic BP data did not. These findings are similar to our findings for …

Letter by Lagro et al Regarding Article, “Average Daily Blood Pressure, Not Office Blood Pressure, Is Associated With Progression of Cerebrovascular Disease and Cognitive Decline in Older People”

To the Editor: With interest we have read the article by White et al.1 In their well-designed prospective cohort study, they demonstrate the importance of increased 24-hour systolic blood pressure, but not clinic systolic blood pressure, in the progression of brain white matter hyperintensity volume burden associated with impairment of cognitive function in older people. They conclude that 24-hour of systolic blood pressure may be a potential target for intervention in older people to reduce vascular disease of the brain and impairment of function. Unfortunately, they did not take blood pressure variability …

EFFICACY OF COMBINED ANTIHYPERTENSIVE THERAPY IN ACHIEVEMENT OF TARGET BLOOD PRESSURE IN DIABETIC PATIENTS

Aim. To evaluate the efficacy of long-term combined antihypertensive therapy (AHT) based on renin-angiotensin-aldosterone system (RAAS) blockers, indapamide and calcium channel blocker (CCB) in hypertensive patients with diabetes mellitus (DM) in accordance with target blood pressure (BP) <130/80 mm Hg achievement rate, dynamics of 24-hour BP profile, metabolic indices, and local stiffness of the main arteries. Besides, to study the effects of the CCB addition to dual therapy on these parameters. Material and methods. Patients (16 men, 31 women, 57.2±6.6 years old) with arterial hypertension degrees 1–3 and mild to moderate DM type 2 were included into the study. The patients were treated with perindopril (5–10 mg/day) or valsartan (80–160 mg/day) in combination with indapamide SR (1.5 mg/day) and amlodipine (5–10 mg/day). Examination included office BP measurement and ambulatory BP monitoring (ABPM), common carotid arteries sonarography , evaluation of serum levels of potassium, creatinine, uric acid, glucose metabolism and lipid profile parameters, calculation of insulin resistance index (HOMA) at baseline and after 30–32 weeks of treatment. Results. Target BP was achieved in 86.7% of patients. Evenly reduction of day and night BP without reflex tachycardia and hypotension episodes was observed. Office BP decreased from 149.5±12.0/90.0±8.3 to 125.0±7.6/76.8±4.9 mm Hg (p<0.05) and average daily BP (ABPM) decreased to 120.1±10.0/71.7±6.9 mmHg. Three drugs were needed to achieve target BP in baseline systolic BP >150 mm Hg (office) or >134 mmHg (ABPM). Marked beneficial effect on the morphological and functional characteristics of the vascular wall and its elastic properties, improvement of glycemic control, tissue insulin sensitivity and lipids profile were found. These effects were associated mainly with amlodipine inclusion into the therapy. Conclusion. The combined AHT based on RAAS blockers, indapamide SR and CCB provides achievement of target BP in the most of hypertensive patients with DM and accompanied by positive changes in vascular remodeling and metabolism.

Average Daily Blood Pressure, Not Office Blood Pressure, Is Associated With Progression of Cerebrovascular Disease and Cognitive Decline in Older People

High blood pressure (BP) is a risk factor for cerebrovascular disease, including stroke. Little is known about the importance of BP on the progression of microvascular disease of the brain, which has been associated with functional decline in mobility and cognition in older people. This was a prospective cohort of subjects 75 to 89 years of age to determine relations among vascular risk factors, white matter hyperintensity volume, and functional status. Ninety-nine subjects were enrolled through the use of a balanced 3×3 matrix stratified by age and mobility performance, and 72 subjects completed all sets of baseline and follow-up studies at 2 years. Subjects were excluded if there were medications or systemic or neurological diseases that could compromise mobility. Ambulatory and clinic BP monitoring, magnetic resonance imaging, gait studies, and neuropsychological testing were performed at baseline and after 24 months. Brain classification into normal white matter and T2-hyperintense white matter hyperintensity volume was performed with semiautomated segmentation. Quantitative measures of mobility and cognitive function were obtained longitudinally. Increased ambulatory systolic BP, but not clinic systolic BP, from baseline to 24 month follow-up was associated with increased white matter hyperintensity volume over that same period, as well as measures of executive function/processing speed. Similar associations were observed for 24-hour BP, awake BP, and sleep BP but not for the surge between the sleep and awake time at the 24-month time point. These data demonstrate for the first time the importance of 24-hour systolic BP in the progression of brain white matter hyperintensity volume burden associated with impairment of cognitive function in older people. The 24-hour systolic BP may be a potential target for intervention in the elderly to reduce vascular disease of the brain and impairment of function.

Quantitative diagnostic criteria of hypertension according to 24-hour blood pressure monitoring

Objective. To study the opportunities of 24-h blood pressure (BP) monitoring in verifi cation of arterial hypertension (AH). Design and methods. The retrospective analysis of the 24-hour BP monitoring results of 395 patients was performed. Sensitivity and specifi city of the hypertensive indices were studied. Results. Ambulatory BP monitoring revealed 90 % of patients, who had BP over 140/90 mm Hg; however within 100 % sensibility, specifi city of this method was only 17 %. Based on the average daily BP (over 130/80 mm Hg) AH was verifi ed in 51 %. This index has 100 % sensitivity and 64 % specifi city. According to the time hypertensive indices ( HISx и HIDx ≥ 50 %) that show the same specifi city and sensitivity AH was established in 28 %, but these values ranging from 30 to 50 % made diffi cult the interpretation of the results The maximal density of BP, refl ecting the range of systolic and diastolic BP values at 10 mm Hg stepout, demonstrates both presence and stage of AH with the specifi city and sensitiviy 82 and 87 % respectively. Conclusion. The application of several highly sensitive and specifi c quantitative indices of 24-h BP monitoring in complex diagnostic approach allows diagnosing AH.

VALUE OF 24-HOUR BLOOD PRESSURE MONITORING IN THE DIAGNOSIS OF ARTERIAL HYPERTENSION IN PATIENTSWITH GOUT

Система комплексной поддержки и сопровождения научного журнала Elpub позволяет запустить двуязычный сайт журнала со встроенной системой электронной редакции в соответствии с лучшими издательскими практиками, а так же предусматривает техническую и методическую поддержку со стороны специалистов НЭИКОН.

Response

Response

Should We Distinguish Between Periventricular and Deep White Matter Hyperintensities?

To the Editor: The recent article by DeCarli et al1 addresses a somewhat neglected aspect of white matter hyperintensities (WMH), the significance of their anatomical location. The authors argue that the commonly accepted categorization into deep (DWMH) and periventricular (PVWMH) WMH is arbitrary, because the 2 are very highly correlated, and a spatial analysis does not reveal distinct populations. We think that this conclusion is premature, because the categorization depends on a number of factors. The first limitation of their analysis is that they examined individuals in their 70s who presented to a specialty clinic, suggesting that the white matter lesions in their sample were at an advanced stage. If an analogy is drawn from cerebral atrophy in dementia, regional differences in atrophy that are present in the different subtypes of dementia become less prominent in the later stages. In our study of WMH in middle age (60 to 64 years), the correlation of DWMH and PVWMH was much lower ( r =0.621; …

The use of peridialysis blood pressure and intradialytic blood pressure changes in the prediction of interdialytic blood pressure in haemodialysis patients.

It is uncertain which blood pressure values (pre- or post-haemodialysis) best represent the average daily blood pressure in haemodialysis patients. The purpose of this study was to verify the power of peridialysis blood pressure to predict interdialytic blood pressure, and to ascertain the influence of blood pressure fluctuations during dialysis on this predictive ability. We performed ambulatory blood pressure monitoring during the interdialytic period on 60 stable haemodialysis patients (mean age 53 +/- 16 years, 33 male) between two mid-week haemodialysis sessions. Pre- and post-haemodialysis blood pressures were 154/82 and 142/77 mmHg, respectively, and 44-h interdialytic blood pressure was 136/77 mmHg. Overall, post-haemodialysis blood pressure values correlated with interdialytic ambulatory blood pressure marginally better than did pre-haemodialysis values (r = 0.52 versus 0.61 for pre- and post-dialysis systolic pressure, respectively; r = 0.67 versus 0.72 for pre- and post-dialysis diastolic pressure, respectively). The average of the pre- and post-haemodialysis values showed a slightly better correlation with interdialytic blood pressure (r = 0.65 and 0.75 for systolic and diastolic pressure, respectively). When we stratified patients according to systolic blood pressure behaviour during dialysis, pre-dialysis blood pressure was the stronger predictor of interdialytic blood pressure in the quartile with greatest intradialytic blood pressure fall (r = 0.67 versus 0.44 for pre- and post-dialysis systolic blood pressure, respectively), whereas post-dialysis values were substantially better in the group with a rise in systolic pressure during dialysis (r = 0.26 versus 0.59 for pre- and post-dialysis systolic blood pressure, respectively). These data demonstrate that peridialysis blood pressure values are of limited accuracy in predicting interdialytic blood pressure, post-dialysis values are minimally better predictors than pre-dialysis blood pressures, and the average of pre- and post-haemodialysis values is marginally better than both. In addition, blood pressure fluctuations during dialysis have a sizable impact on this predictive ability. Clinical decisions related to blood pressure management and research design in haemodialysis hypertension should take these factors into account.