Kidney Res Clin Pract 2019 Jun; 38(2): 212-219  
Comparisons between different blood pressure measurement techniques in patients with chronic kidney disease
Shahrokh Ezzatzadegan Jahromi1 , Ghasem Haghighi2 , Jamshid Roozbeh1 , Vahid Ebrahimi1,3,4
1Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2Department of Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
3Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
4Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Correspondence to: Vahid Ebrahimi
Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. E-mail: biostat.ebrahimiv@gmail.com
Received: September 12, 2018; Revised: February 7, 2019; Accepted: February 23, 2019; Published online: June 30, 2019.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Automated office blood pressure (AOBP) machines measure blood pressure (BP) multiple times over a brief period. We aimed to compare the results of manual office blood pressure (MOBP) and AOBP methods with ambulatory BP monitoring (ABPM) in patients with chronic kidney disease (CKD).
Methods: This study was performed on 64 patients with CKD (stages 3–4). A nurse manually measured the BP on both arms using a mercury sphygmomanometer, followed by AOBP of the arm with the higher BP and then ABPM. Mean BP readings were compared by paired t test and Bland–Altman graphs.
Results: The mean ± standard deviation (SD) age of participants was 59.3 ± 13.6. The mean ± SD awake systolic BP obtained by ABPM was 140.2 ± 19.0 mmHg, which was lower than the MOBP and AOBP methods (156.6 ± 17.8 and 148.8 ± 18.6 mmHg, respectively; P < 0.001). The mean ± SD awake diastolic BP was 78.6 ± 13.2 mmHg by ABPM which was lower than the MOBP and AOBP methods (88.9 ± 13.2 and 84.1 ± 14.0 mmHg, respectively; P < 0.001). Using Bland–Altman graphs, MOBP systolic BP readings showed a bias of 16.4 mmHg, while AOBP measurements indicated a bias of 8.6 mmHg compared with ABPM.
Conclusion: AOBP methods may be more reliable than MOBP methods for determining BP in patients with CKD. However, the significantly higher mean BPs recorded by AOBP method suggested that AOBPs may not be as accurate as ABPM in patients with CKD.
Keywords: Ambulatory blood pressure monitoring, Chronic renal insufficiency, Hypertension, Sphygmomanometers


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