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Haemodialysis‐unresponsive blood pressure: Cardiovascular mortality predictor?
Author(s) -
MOURAD ADNAN,
KHOSHDEL ALIREZA,
CARNEY SHANE,
GILLIES ALASTAIR,
JONES BERNARD,
NANRA RANJIT,
TREVILLIAN PAUL
Publication year - 2005
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2005.00467.x
Subject(s) - medicine , blood pressure , pulse wave velocity , cardiology , asymptomatic , pulse pressure , population , ambulatory blood pressure , diastole , cohort , environmental health
SUMMARY: Aim: The importance of ‘conventional’ cardiovascular risk factors in haemodialysis (HD) patients has been questioned following evidence that pre‐HD blood pressure (BP) might be inversely related to mortality in contrast to post‐HD BP. To evaluate this reverse BP epidemiology in HD patients, HD‐induced BP changes were compared with aortic pulse wave velocity (PWV), an independent predictor of cardiovascular mortality. Method: Aortic PWV was evaluated in a limited care HD cohort, all of whom were asymptomatic of cardiovascular disease. Results: Of 47 limited care patients, 45% were classified as HD responsive, with a 17% fall in mean arterial pressure compared with a 6% increase in the HD‐unresponsive group. While there were no significant differences between the two groups in traditional vascular disease risk factors or interdialytic weight loss, PWV was significantly elevated in the HD‐unresponsive group (12.9 ± 2.7 compared with 10.8 ± 2.9; P < 0.05). Furthermore, there was a positive correlation between the change in BP during HD and PWV in all subjects ( r = 0.500; P < 0.001 for systolic blood pressure (SBP), a correlation that also existed for diastolic blood pressure (DBP) ( P < 0.01). Conclusion: This study suggests that patients with HD‐unresponsive BP are more likely to have vascular disease and this association between PWV and HD‐induced BP changes might partly explain the apparent paradox of pre‐ and post‐HD BP with mortality. It is proposed that a population with elevated post‐HD BP is more likely to be composed of subjects with vascular disease (overt or occult), in contrast to a group with high pre‐HD BP, which will be more heterogeneous.