Nocturnal blood pressure and 24-hour pulse pressure are potent indicators of mortality in hemodialysis patients
| Autor: | Jacques Amar, Vernier I, Elisabeth Rossignol, Catherine Arnaud, Jean J. Conté, Bernard Chamontin, Vanina Bongard, Michel Salvador |
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| Rok vydání: | 2000 |
| Předmět: |
Adult
Male medicine.medical_specialty Ambulatory blood pressure medicine.medical_treatment Population Diastole Blood Pressure cardiovascular mortality Renal Dialysis Internal medicine Medicine Humans education Pulse ambulatory blood pressure Dialysis Antihypertensive Agents Aged education.field_of_study hemodialysis business.industry pulse pressure Middle Aged Prognosis Pulse pressure Surgery Circadian Rhythm Blood pressure Nephrology Cardiovascular Diseases Ambulatory Hypertension Cardiology Female Hemodialysis business |
| Zdroj: | Kidney international. 57(6) |
| ISSN: | 0085-2538 |
| Popis: | Nocturnal blood pressure and 24-hour pulse pressure are potent indicators of mortality in hemodialysis patients. Background Cardiovascular (CV) complications are the leading cause of mortality in hemodialysis patients. The role of arterial hypertension on the prognosis of CV in hemodialysis patients is not as clear as in the general population. The purpose of this study was to investigate the prognostic role of ambulatory blood pressure (BP) on CV mortality in treated hypertensive hemodialysis patients. Methods Fifty-seven treated hypertensive hemodialysis patients (56.87 ± 16.22 years, 30 men) were prospectively studied. All patients initially underwent an ambulatory BP monitoring between two dialysis sessions. The outcome event studied was CV death; kidney transplantation and deaths not related to CV disease were censored. Results The duration of follow-up was 34.4 ± 20.39 months, during which 10 CV and 8 non-CV fatal events occurred. In the 10 patients who died from CV complications, age, previous CV events, ambulatory systolic BP, ambulatory pulse pressure (PP), and life-long smoking level were significantly higher, and the office diastolic BP was lower at the time of inclusion than in those who did not die from CV complications ( N = 47). Based on Cox analysis and after adjustment for age, sex, and previous CV events, a low office diastolic BP [relative risk (RR) 0.49, 95% CI, 0.25 to 0.93, P = 0.03], an elevated 24-hour PP (RR 1.85, 95% CI, 1.28 to 2.65, P = 0.009), and an elevated nocturnal systolic BP (RR 1.41, 95% CI, 1.08 to 1.84, P = 0.01) were predictors of CV mortality (RR associated with a 10 mm Hg increase in BP and in PP). Conclusion This study demonstrates that nocturnal BP and 24-hour PP are independent predictors of CV mortality in treated hypertensive hemodialysis patients. Randomized trials are needed to investigate whether nocturnal BP and 24-hour PP are superior to office BP as targets for antihypertensive therapy in this high-risk group. |
| Databáze: | OpenAIRE |
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