Chapter 8: Future directions and controversies

8.1: ASSESSMENT OF BP The RCTs on which this Guideline is based involved standard office BP measurements, with the exception of the ESCAPE trial in children. In clinical practice BP assessment typically involves measurements made in the clinic or ‘office.’ In RCTs, the protocols for BP measurement usually require one or more BP readings taken after a period of rest and avoiding prior activities that may have effects on BP. As far as it is possible these protocols should be followed in clinical practice if this evidence is used to guide management. The techniques for office BP measurement and associated problems are well described in the hypertension literature. There is no reason to believe that office BP measurement should be performed differently in CKD patients than in non-CKD patients, other than a strong emphasis be placed on measuring supine or sitting and standing BP because of the increased likelihood of orthostatic hypotension associated with volume depletion, autonomic neuropathy, older age, and drug effects. Measuring BP in the general community and in particular, patients with ‘essential’ hypertension, is becoming increasingly sophisticated. Examples include technologies that assess ‘usual’ BP as distinct from the BP measured at an office visit and new ways of measuring BP, beyond just systolic and diastolic pressures. Gradually, these advances are being implemented in research and BP management in CKD patients.