MEOTO PN¹; ASHUNTANTANG G^1,2; A. MENANGA^1,2; A. NONO A²; NSOUNFON A¹; I;  KINGUE S¹²

1. Faculty of Medicine and Biomedical Sciences; University of Yaounde Ι

 2.Yaounde General Hospital, Cameroon

Introduction: Optimal blood pressure control slows progression of chronic kidney disease. We sought to determine the agreement between blood pressure control evaluated by home and ambulatory blood pressure measurements in patients with non-dialyzed chronic kidney disease (CKD).

Methods: Consenting hypertensive non-dialyzed CKD patients stages 3-5 ND who at the Yaounde General Hospital (YGH), from November 2013 to March 2014 were enrolled. Patients with debilitating illness and incomplete blood pressure recordings were excluded.  The average of 3 seated blood pressure (BP) measurements and 3 standing blood pressure measurements was considered as the office BP while Home BP was an average of 9 daily measurements taken on four consecutive days. Omron M2 basic” electronic sphygmomanometer was used for office and home measurements. Ambulatory BP was measured for 24 hours using an automatic device (A&D TM 2430). 

Results: A total of 35 (21 M) patients were enrolled. Their mean age was 58(11) years. The median glomerular filtration rate (eGFR) was 31 ml/min/ 1.73 m2 with 20% of patients in stage 5 CKD. The mean number of drugs was 2.17(0.99) and 54.4% of the study population were on ≥ 3 antihypertensives. Optimal blood pressure control was observed in 20%, 31% and 26% by office, home and ambulatory measurements (ABPM) respectively. Office BP and ABPM had an agreement of 33.3% with respect to optimal control while home measurements had an agreement of 100% with ABPM. Home BP had an almost perfect (kappa=0.86) with ABPM. In Receiver Operating Characteristic (ROC) curves, the area under the curve (AUC) for the office systolic and diastolic BP were 0.87 and 0.81 respectively while those for home BP were 0.97 and 0.98 respectively.

Conclusion: Home blood pressure monitoring is a useful tool in the evaluation of blood pressure control and may therefore replace the more expensive ABPM.

Key words:  Blood pressure control, non-dialyzed CKD, ambulatory blood pressure.