To Compare Different Blood Pressure Measurement Techniques in Patients with Chronic Kidney Disease.

Abstract

Background: Accurate blood pressure (BP) measurement is critical in patients with chronic kidney disease (CKD) due to its strong association with cardiovascular morbidity and progression of renal dysfunction. While ambulatory BP monitoring (ABPM) is considered the gold standard, it is often impractical in routine settings. This study compares manual office BP (MOBP), automated office BP (AOBP), and ABPM to evaluate diagnostic accuracy and clinical utility in CKD patients.

Materials and methods: This cross-sectional observational study was conducted in 120 patients with established CKD. BP measurements were recorded using MOBP, AOBP, and ABPM over a 24-h period. Comparative analysis was performed for systolic and diastolic BP values, uncontrolled hypertension, and identification of phenotypes such as white-coat hypertension (WCH) and masked hypertension (MHT). Statistical significance was evaluated using paired t -tests and ROC curve analysis.

Results: Mean systolic and diastolic BP values were significantly higher with MOBP (131.55 ± 16.88/87.42 ± 10.56 mmHg) compared to ABPM (130.11 ± 17.60/84.35 ± 10.81 mmHg, P < 0.05). AOBP values closely matched ABPM (130.45 ± 17.53/84.63 ± 10.80 mmHg, P > 0.4). Uncontrolled hypertension was noted in 30.8% (MOBP, AOBP) and 27.5% (ABPM). WCH and MHT were identified in 6.5% and 3.5% of patients, respectively. AOBP demonstrated high sensitivity (95.8%) and specificity (94.4%) relative to ABPM.

Conclusion: AOBP closely approximates ABPM and can be considered a reliable alternative for BP evaluation in CKD patients, particularly in resource-limited settings. MOBP significantly overestimates BP and may lead to diagnostic misclassification.