Hypertension is common amongst patients with chronic kidney disorder and often remains poorly managed in hemodialysis patients. Recently, a large cohort study discovered that the range of blood pressure (BP) within patients was at least as notable as variability visible among patients.BP obtained in the dialysis unit through technicians and nurses without attention to detail differs strikingly from BP obtained using standard techniques. Nearly half the systolic BP is more than 10 mm Hg different from routine BP while standard techniques of measurements are used. BP obtained earlier than and after dialysis, even if obtained using standardized techniques, agrees poorly with interdialytic ambulatory BP. Furthermore, even standardized BP recordings can’t be used to predict the presence or absence of left ventricular hypertrophy. In contrast, BP acquired outside the dialysis unit, whether or not acquired through interdialytic automatic BP measurement or self-measured BP at home is beneficial in diagnosing left ventricular hypertrophy. Thus, dialysis unit measurement is only distantly associated with ambulatory BP or target organ damage.

Dialysis unit blood pressures neither are expecting target organ harm nor all-cause mortality in relatively healthy dialysis patients. Thus, in dialysis patients more so than in the standard population, blood pressure measurement and treatment should occur with recordings made outside the clinic. The consequences of the study support the view out of dialysis unit BP being crucial for prognostication of mortality even after adjustment for nonconventional risk factors. Causality can’t be implied in a cohort study; however, this study can also additionally provide a few guidelines with respect to BP goals. Self-measured systolic BP of ≈120 to 130 mm Hg and of ≈110 to 120 mm Hg through ambulatory BP are related to the best prognosis. These thresholds can be used to check the hypothesis if controlling high blood pressure in hemodialysis patients using out-of-dialysis unit blood pressure recordings could make a difference to cardiovascular mortality.

Lacking large scale and desirable best clinical trials, there are many questions to be answered. These consist of the optimal methods to measure BP, target BP levels, suitable guidelines of body fluid volume, anti-hypertensive drugs to be used, and so on for patients on dialysis therapy. Currently, there’s no method of treating high blood pressure with the best available knowledge, although it isn’t always perfect. But for the future, we should continue to make efforts to create higher evidence about control of high blood pressure for those people.