Document Detail


Nocturnal blood pressure and 24-hour pulse pressure are potent indicators of mortality in hemodialysis patients.
MedLine Citation:
PMID:  10844617     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
J Amar; I Vernier; E Rossignol; V Bongard; C Arnaud; J J Conte; M Salvador; B Chamontin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Kidney international     Volume:  57     ISSN:  0085-2538     ISO Abbreviation:  Kidney Int.     Publication Date:  2000 Jun 
Date Detail:
Created Date:  2000-08-24     Completed Date:  2000-08-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2485-91     Citation Subset:  IM    
Affiliation:
Service de Médecine Interne et d'Hypertension Artérielle and Service de Néphrologie et d'Hémodialyse, CHU Purpan; and Département d'Epidémiologie, d'Economie de la Santé et de Santé Communautaire, Toulouse, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Antihypertensive Agents / therapeutic use
Blood Pressure*
Cardiovascular Diseases / mortality*
Circadian Rhythm*
Female
Humans
Hypertension / drug therapy,  physiopathology
Male
Middle Aged
Prognosis
Pulse*
Renal Dialysis*
Chemical
Reg. No./Substance:
0/Antihypertensive Agents

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