Abstract: 【Abstract】 Objective To investigate home blood pressure variability in maintenance hemodialysis patients(MHD) with hypertension , and then observe the effects of individualized therapeutic interventions on home blood pressure variability in these patients. Methods Home blood pressure monitoring was carried out in stable MHD in our hospital. The coefficient of variation(CV) was used as indicator parameters for variability of home blood pressure. Home systolic blood pressure ≥ 150mmHg was defined as uncontrolled hypertension. Patients with uncontrolled hypertension were subject to bioimpendance analysis, serum sodium measurement, and antihypertensive agent evaluation. Individualized interventions including reducing dry body weight, negative sodium gradient dialysis and re-adjusting antihypertensive agents were applied accordingly. The patients were followed for 2 months, home blood pressure and blood pressure variability were monitored. Results Total 105 MHD patients conducted home blood pressure monitoring. The average CV of home blood pressure was 4.8±2.2/5.0±2.4%. Among the 105 patients, 60 patients were determined as uncontrolled hypertensive patients(57.1%). After the individualized interventions, home blood pressure fell from 166.3±12.6/87.5±11.7mmHg to 154.1±14.2/82.6±11.4mmHg（P<0.001,T=7.223,P<0.001,T=4.796）， home systolic blood pressure variability fell from 4.9±2.2% to 4.6±2.5%. Thirty overhydrated patients had their dry body weight reduced under guidance of bioimpedance technique, which resulted in significant decreases in home blood pressure, CV of home systolic and diastolic blood pressure (0.4% and 0.1%) and dose of antihypertensive agents. Twelve patients were subject to negative sodium gradient dialysis, significant decrease in home blood pressure were discovered, however, there is no difference in home blood pressure variability was detected. The other 18 patients had their home blood pressure significantly reduced by re-adjusting antihypertensive drugs; no siginificant change in coefficient of variation of home blood pressure was found. Conclusions Individualized interventions can improve home blood pressure control and blood pressure variability.

Key words: hemodialysis, hypertension, home blood pressure mornitoring, blood pressure variability