Increased Nighttime Pulse Pressure Variability but Not Ambulatory Blood Pressure Levels Predicts 14-Year All-Cause Mortality in Patients on Hemodialysis
| Autor: | Shih Hsien Sung, Wen Chung Yu, Chen Huan Chen, Jui Tzu Huang, Yao Ping Lin, Hao Min Cheng |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Ambulatory blood pressure medicine.medical_treatment 030232 urology & nephrology Hemodynamics Blood Pressure Pulse Wave Analysis 030204 cardiovascular system & hematology Severity of Illness Index Cohort Studies 03 medical and health sciences 0302 clinical medicine Renal Dialysis Cause of Death Internal medicine Internal Medicine medicine Humans In patient Aged Proportional Hazards Models Retrospective Studies business.industry Blood Pressure Monitoring Ambulatory Middle Aged medicine.disease Survival Analysis Uremia Circadian Rhythm Pulse pressure Blood pressure Hypertension Multivariate Analysis Cardiology Kidney Failure Chronic Female Hemodialysis business All cause mortality |
| Zdroj: | Hypertension. 74:660-668 |
| ISSN: | 1524-4563 0194-911X |
| DOI: | 10.1161/hypertensionaha.119.13204 |
| Popis: | Increased short-term blood pressure (BP) variability is associated with adverse cardiovascular outcomes in patients with hypertension. The present study investigated the long-term prognostic significance of the short-term blood pressure variability in patients on hemodialysis. A total of 149 patients (53.0% male; mean age: 54.5±15.1 years) receiving regular hemodialysis for >6 months were enrolled. They completed a 44-hour (excluding the hemodialysis session) ambulatory BP monitoring and comprehensive hemodynamic assessments, including carotid-femoral pulse wave velocity and pressure waveform decomposition (forward and backward wave amplitude). Blood pressure variability parameters, including average real variability (ARV) of systolic BP, diastolic BP, and pulse pressure (ARVp) during daytime, nighttime, and overall 44 hours were calculated. During a median follow-up of 14 years, 78 deaths (52.4%) were confirmed. In multivariable Cox regression analysis, none of the ambulatory BP parameters were predictive of mortality. In contrast, nighttime ARVp was consistently and significantly associated with all-cause mortality in multivariable Cox models adjusting for age, sex, albumin, hemodialysis treatment adequacy, and 44-hour systolic BP (continuous variable analysis, per 1-SD, hazard ratio=1.348; 95% CI, 1.029–1.767; categorical variable analysis, ≥8.5 versus P =0.0012). In hemodialysis patients, increased short-term nighttime pulse pressure variability but not ambulatory BP levels were significantly predictive of long-term all-cause mortality. |
| Databáze: | OpenAIRE |
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