title: In-office assessment of blood pressure in chronic kidney disease: usual measurement versus automated BpTRU measurement.
abstract: OBJECTIVE
  The automated BpTRU device has been shown to improve the accuracy of in-office blood pressure assessment in hypertensive populations. We aimed to determine whether this was also true for patients with chronic kidney disease.
  
  
  METHODS
  We recorded the blood pressure of 80 hypertensive outpatients with chronic kidney disease by usual automated measurement and BpTRU automated measurement. We established whether there were any statistically significant differences in the absolute blood pressure values measured by either method and whether these differences had any impact on the assessment of blood pressure control.
  
  
  RESULTS
  Systolic and diastolic blood pressures were significantly lower by BpTRU measurement than by usual measurement, by 10.1±12.2 mmHg (95% confidence interval: 7.4-12.8 mmHg, P<0.001) and 2.8±10.6 mmHg (95% confidence interval: 0.4-5.1 mmHg, P=0.02), respectively. Significantly, more patients achieved their blood pressure target of 130/80 mmHg or less by BpTRU measurement than by usual measurement (72.5 vs. 48.8% for systolic blood pressure, P<0.001; 68.8 vs. 61.3% for diastolic blood pressure, P=0.02). Systolic blood pressures remained significantly lower by BpTRU measurement than by usual measurement in all predefined study subgroups (estimated glomerular filtration rate <30 vs ≥30 ml/min/1.73m; transplant vs. nontransplant). We detected more hypotension by BpTRU measurement than by usual measurement.
  
  
  CONCLUSIONS
  Our study suggests that the BpTRU device can negate white coat effect in patients with chronic kidney disease. The use of this device in routine clinical practice could improve the overall accuracy of in-office blood pressure assessment in this high-risk population, minimizing the potential for undertreatment and overtreatment of hypertension.
authors.affiliation: Department of Nephrology, Hospital Ground, Galway University Hospitals, Ireland. michelleoshaugh@gmail.com
authors.forename: Michelle M
authors.initials: MM
authors.lastname: O'shaughnessy
authors.forename: Christine A
authors.initials: CA
authors.lastname: Newman
authors.forename: Sinead M
authors.initials: SM
authors.lastname: Kinsella
authors.forename: Donal N
authors.initials: DN
authors.lastname: Reddan
authors.forename: David W
authors.initials: DW
authors.lastname: Lappin
mesh_terms: D000328:Adult; D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory; D015924:Blood Pressure Monitors; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology* / Q000628:therapy; D007674:Kidney Diseases / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged