Dr Hardik Shah, Dr Nikhil Bhasin, Dr Hardik Shah, Dr Dilip Kirpalani, Dr Ashok Kirpalani; Mumbai

A single clinic BP reading (by sphygmomanometer) may be useful but does not reflect the true 24-hour BP pattern. Additionally, there is a high incidence of white-coat effect in CKD patients. BP in resting state is more important in reducing target organ damage. 24-hour ambulatory BP is costly and cumbersome and not easily accepted by patients. Therefore, a simple surrogate is the need of the hour - Home BP; automated office BP (AOBP). This study included 160 CKD outpatients who needed 24-hour ABPM. They underwent prior office BP measurements with 3 methods - single sphygmomanometric BP (SPBP), single observed oscillometric BP (SOBP) and AOBP. These readings were then compared with average daytime ABPM.

The study concluded that AOBP is a very useful and cost-effective alternative to 24-hour ABPM in the assessment of white-coat effect in CKD. AOBP better predicts the average daytime ABPM as compared to routine mercury (SPBP)/SOBP office BP measurements. The AOBP method clearly scores over SOBP in eliminating much of the white-coat effect. Therefore, universal use of AOBP is recommended in CKD to avoid unnecessary over-aggressive reduction of BP in an attempt to reduce target organ damage.