부산대학교 도서관

OBJECTIVE:: We previously reported results of a European survey suggesting that standard recommendations for blood pressure (BP) measurement are poorly followed in dialysis centres. The objectives of the current sub-study were (i) to compare adherence to office BP measurement guidelines in dialysis centres reported by patients vs. physicians; (ii) to evaluate use of out-of-office BP measurements in the same patients. DESIGN AND METHOD:: An online questionnaire, including 16 items on correct BP measurement, was sent to 600 members of the Working Groups EURECA-m (ERA/EDTA) and “Hypertension and the Kidney” (ESH). The total adherence score was calculated and differences between physician and patient were assessed. Besides the main questionnaire, additional questions on demographics, type of dialysis and out-of-office BP measurements were collected in patients only. RESULTS:: Among the 95 dialysis centres participating to the survey, 14 collected questionnaires filled both by physicians (n = 14) and patients (n = 210). Patients were predominantly men (69%) and treated by haemodialysis (96%). No difference was found in the median score between physicians and patients (12 [8–13] vs.10 [9–12], p = 0.1). However, the proportion of physicians adhering to >/ = 80% of recommendations was 35.7% according to physicians vs. only 13.8% according to patients (p < 0.027). In particular, physicians overestimated correct adherence to recommendations, such as BP measurement in a still environment (p < 0.017), at both arms at least once (p < 0.006) and not putting the cuff over clothes (p < 0.001). Finally, only a minority of patients used self BP measurement regularly and only 44% ever performed a 24-hour BP measurement. CONCLUSIONS:: Standard recommendations on BP measurement are poorly followed in dialysis centres according to physicians themselves, and even less according to patients. Furthermore, self and ambulatory BP measurements are underused. Poor BP measurement technique may contribute the poor correlation with outcomes in dialysis patients. Hence, improving office and out-of-office BP measurement in dialysis patients is a priority.