Comparative associations of home and dialysis-unit blood pressure with left ventricular mass and arterial stiffness in maintenance hemodialysis patients.

Blood pressure (BP) measured in dialysis units is often elevated due to white-coat reactivity, yet it remains the usual reference for antihypertensive therapy in hemodialysis patients. We compared standardized home BP with routine unit BP and examined their associations with cardiovascular target-organ damage. In this cross-sectional study of 216 thrice-weekly hemodialysis patients, participants measured home BP twice daily for seven consecutive days (14 readings). During the same week, six pre- and six post-dialysis unit readings were obtained. Three home metrics were derived: weekly average, dialysis-day mean, and non-dialysis-day mean. Outcomes were left ventricular mass index (LVMI) and brachial-ankle pulse wave velocity (baPWV). Pre-dialysis systolic BP in the dialysis unit exceeded contemporaneous home systolic BP by 13 mmHg, whereas the actual interdialytic rise-from post-dialysis nadir to subsequent pre-dialysis home peak-was only 7.5 mmHg. This suggests environmental rather than volume-related factors explain most of the discrepancy. After multivariable adjustment, each standard deviation increase (about 20 mmHg) in dialysis-day home systolic BP was associated with 1.89-fold higher odds of LVH and 2.40-fold higher odds of arterial stiffness. Average home systolic BP yielded similar effect sizes. By contrast, dialysis-unit systolic BP conveyed 40-60% weaker risks, and dialysis-unit diastolic BP was not significantly related to LVH. In head-to-head models, only home systolic BP remained significant. Standardized home BP more accurately reflects interdialytic hemodynamic load and provides a stronger indicator of myocardial hypertrophy and large-artery stiffness. Incorporating home BP monitoring into dialysis care may reduce overtreatment driven by white-coat effects and improve cardiovascular risk assessment.