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Increased blood pressure variability may yield higher risk of death in patients on hemodialysis
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Recently published results showed patients with ESRD undergoing hemodialysis had a higher risk of death and cardiovascular events if they had increased blood pressure variability during the interdialytic interval.
Researchers calculated standard deviation, weighted standard deviation, coefficient of variation and average real variability of blood pressure among 227 patients undergoing hemodialysis and 44-hour ambulatory monitoring. All-cause death or first occurrence of nonfatal myocardial infarction or non-fatal stroke was considered the primary endpoint, while secondary endpoints included all-cause mortality, cardiovascular mortality and a combination of cardiovascular events.
Results showed quartiles of pre-dialysis and 44-hour systolic blood pressure had similar cumulative freedom from the primary endpoint. However, researchers found increasing quartiles of 44-hour systolic blood pressure-standard deviation, weighted standard deviation, coefficient of variation and average real variability had progressively longer cumulative freedom. Researchers noted an association between higher quartiles of 44-hour systolic blood pressure-average real variability and higher risk of all studied outcomes. Patients with 44-hour diastolic blood pressure coefficient of variation and 44-hour diastolic blood pressure-average real variability had an increased risk for the composite cardiovascular outcome, according to results.
Cox regression analysis showed a relationship between systolic blood pressure blood pressure variability and the primary endpoint, independently of systolic blood pressure levels and interdialytic weight gain. However, after adjustment for pulse wave velocity, researchers found this association became insignificant and the association became further attenuated after additional adjustment for age, dialysis vintage, gender, comorbidities and prevalent cardiovascular disease.
‘These results suggest that short-term [blood pressure variability] BPV is an additional variable involved in the adverse cardiovascular pathophysiology of these individuals,” the authors wrote. “Further studies are warranted to investigate whether BPV reductions through non-pharmacological (ie, minimization of interdialytic sodium and water gain, or more frequent dialysis) and pharmacologic (ie, longer-acting drugs) measures could reduce future cardiovascular events in these patients.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
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