Blood Pressure Measurement: A KDOQI Perspective

Abstract

The majority of patients with chronic kidney disease (CKD) have elevated blood pressure (BP). In patients with CKD, hypertension is associated with increased risk for cardiovascular disease, progression of CKD, and all-cause mortality. New guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) recommend new thresholds and targets for the diagnosis and treatment of hypertension in patients with and without CKD. A new aspect of the guidelines is the recommendation for measurement of out-of-office BP to confirm the diagnosis of hypertension and guide therapy. In this KDOQI (Kidney Disease Outcomes Quality Initiative) perspective, we review the recommendations for accurate BP measurement in the office, at home, and with ambulatory BP monitoring. Regardless of location, validated devices and appropriate cuff sizes should be used. In the clinic and at home, proper patient preparation and positioning are critical. Patients should receive information about the importance of BP measurement techniques and be encouraged to advocate for adherence to guideline recommendations. Implementing appropriate BP measurement in routine practice is feasible and should be incorporated in system-wide efforts to improve the care of patients with hypertension. Hypertension is the number 1 chronic disease risk factor in the world; BP measurements in the office, at home, and with ambulatory BP monitoring should adhere to recommendations from the AHA.

Keywords: Hypertension; ambulatory blood pressure monitoring (ABPM); best practices; blood pressure determination; blood pressure variation; chronic kidney disease (CKD); home blood pressure monitoring; measurement accuracy; patient education; quality improvement.

Figure 1.

Proportion of systolic blood pressure readings from primary care visits by chronic kidney disease (CKD) status.

Figure 2.

Improper (left) and proper (right) blood pressure measurement technique. Original image © Tom Mattix; reproduced with permission of the copyright holder.