# N6 — Blood Pressure at the Chair

N6 — Blood Pressure at the Chair FRONT Front · at the chair

**When:** any high or low reading before, during, or after treatment.

### Do this

1.  **Measure it right:** seated, rested, correct cuff, non-access arm. Repeat a high reading after a few minutes’ rest before acting on it.
2.  **Record the lowest systolic BP (SBP) every treatment.** SBP below 90 — or below 100 if pre-dialysis SBP was 160 or higher — gets the hypotension response even if the patient feels fine; so do symptoms at any number ([N5: Intradialytic Hypotension: Chair-Side Response](https://urinenephrology.org/mastery/maintenance-hd/nursing/N5-Intradialytic-Hypotension-Response.html)) \[[3](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-3),[5](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-5)\].
3.  **Isolated high pre-dialysis reading, no symptoms:** recheck after rest, document, trend. No extra antihypertensive and no extra UF on the strength of that reading \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-1)\].
4.  **Track the pattern:** an SBP rise of more than 10 mmHg from pre- to post-dialysis into the hypertensive range in 4 of 6 consecutive treatments is a flag for review \[[5](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-5)\].
5.  **Home BP log:** validated upper-arm device, two readings morning and evening for about a week, including non-dialysis days. A home average of 135/85 or higher is hypertension \[[6](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-6)\].
6.  **BP medicines on dialysis days: take them as prescribed** unless the nephrologist has ordered a specific drug held or moved to the evening \[[4](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-4),[7](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-7)\].

### Call the nephrologist when

- **Severe hypertension with chest pain, shortness of breath, new neurologic deficit, confusion, severe headache, or visual change** — an emergency per unit protocol. Symptoms matter more than the number.
- Hypotension that does not recover, or comes with chest pain, arrhythmia, or confusion.
- Nadir SBP below 90 in 30% or more of treatments over the past month \[[3](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-3),[5](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-5)\].
- The target weight cannot be reached without a UF rate above 13 mL/kg/h ([N4: UF Rate and Treatment Time](https://urinenephrology.org/mastery/maintenance-hd/nursing/N4-UF-Rate-and-Treatment-Time.html)).
- The intradialytic hypertension pattern (4 of 6 treatments), or pre-dialysis BP of 180/110 or higher on two consecutive treatments — the level DRIP used to trigger ambulatory monitoring \[[8](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-8)\].
- Home average 135/85 or higher, or new low home readings with dizziness or falls \[[6](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-6)\].

### Don’t

- Don’t give a PRN antihypertensive for an asymptomatic high chair-side reading.
- Don’t lower the target weight or raise UF because of one high pre-dialysis BP.
- Don’t tell patients to hold BP medicines before dialysis unless ordered for that patient \[[4](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-4)\].

N6 — Blood Pressure at the Chair BACK Back · why, and the evidence

### Why

1.  Pre- and post-dialysis SBP did not predict death once home and ambulatory BP were measured (P = 0.17 and 0.997); home and ambulatory SBP did \[[1](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-1)\].
2.  One week of home readings identified true hypertension better than two weeks of pre-dialysis readings (AUC 0.934 vs 0.778) \[[2](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-2)\].
3.  A nadir SBP below 90 in 30% or more of treatments carried higher mortality (adjusted HR 1.22–1.38); requiring symptoms did not improve the signal \[[3](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-3)\].
4.  In the one randomized test, taking BP medicines before dialysis could not be shown as good as holding them for asymptomatic hypotension (8% more; 95% CI −3% to 19%), but uncontrolled pre-dialysis hypertension was less frequent (difference 15%) \[[4](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-4)\]. UK guidance advises against routine omission \[[7](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html#n6-ref-7)\].

### Go deeper

- Mastery page: [Which blood pressure matters: measurement and prognosis](https://urinenephrology.org/mastery/maintenance-hd/blood-pressure-measurement-dialysis.html)
- Mastery page: [Treating hypertension on dialysis: targets, trials, agents, dose timing](https://urinenephrology.org/mastery/maintenance-hd/treating-hypertension-dialysis.html)
- Mastery page: [Intradialytic hypertension and the stability trade-off](https://urinenephrology.org/mastery/maintenance-hd/intradialytic-hypertension.html)
- [All dialysis nursing reference cards](https://urinenephrology.org/mastery/maintenance-hd/nursing/index.html)

### References

1.  Agarwal R. Blood pressure and mortality among hemodialysis patients. *Hypertension.* 2010;55:762-768. [PubMed 20083728](https://pubmed.ncbi.nlm.nih.gov/20083728/)
2.  Leonidou K, et al. Home versus routine dialysis-unit blood pressure recordings among patients on hemodialysis. *J Hum Hypertens.* 2025;39:355-361. [PubMed 40097627](https://pubmed.ncbi.nlm.nih.gov/40097627/)
3.  Flythe JE, et al. Association of mortality risk with various definitions of intradialytic hypotension. *J Am Soc Nephrol.* 2015;26:724-734. [PubMed 25270068](https://pubmed.ncbi.nlm.nih.gov/25270068/)
4.  Chang TI, et al. Timing of antihypertensive medications on key outcomes in hemodialysis (TAKE-HOLD). *Kidney360.* 2021;2:1752-1760. [PubMed 35373003](https://pubmed.ncbi.nlm.nih.gov/35373003/)
5.  Flythe JE, et al. Blood pressure and volume management in dialysis: conclusions from a KDIGO Controversies Conference. *Kidney Int.* 2020;97:861-876. [PubMed 32278617](https://pubmed.ncbi.nlm.nih.gov/32278617/)
6.  Sarafidis PA, et al. Hypertension in dialysis patients: a consensus document by EURECA-m and the ESH Hypertension and the Kidney working group. *Nephrol Dial Transplant.* 2017;32:620-640. [PubMed 28340239](https://pubmed.ncbi.nlm.nih.gov/28340239/)
7.  Doulton T, et al. Management of blood pressure in adults, children and young people on dialysis: UK Kidney Association guideline. *BMC Nephrol.* 2025;26:532. [PubMed 41013409](https://pubmed.ncbi.nlm.nih.gov/41013409/)
8.  Agarwal R, et al. Dry-weight reduction in hypertensive hemodialysis patients (DRIP). *Hypertension.* 2009;53:500-507. [PubMed 19153263](https://pubmed.ncbi.nlm.nih.gov/19153263/)

Reviewed by Andrew Bland, MD, FACP, FAAP · v1.0 draft 2026-09-26. For education; the physician’s written order and the unit protocol always govern.


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[Website version](https://urinenephrology.org/mastery/maintenance-hd/nursing/N6-Blood-Pressure-at-the-Chair.html) · Markdown synchronized October 3, 2026.