SP487INTERLEG SYSTOLIC BLOOD PRESSURE DIFFERENCE AS PREDICTOR OF CARDIOVASCULAR EVENTS IN INCIDENT DIALYSIS PATIENTS: A JAPANESE PROSPECTIVE COHORT STUDY

ObjectiveThis study was performed to explore the effects of visit-to-visit blood pressure variability (BPV) on cardiovascular events (CVEs) in people with various body mass indexes (BMIs).DesignProspective cohort study.SettingThe average real variability of systolic blood pressure (ARVSBP) was the indicator for visit-to-visit BPV. The participants were divided into three groups: normal weight, overweight and obesity. We further divided these groups into four subgroups based on the ARVSBP. A Cox regression model was used to calculate the HRs of the ARVSBP on CVEs in the same and different BMI groups. Additionally, a competitive risk model was used to calculate the HRs of the ARVSBP on CVEs in the same BMI group.ParticipantsIn total, 41 043 individuals met the inclusion criteria (no historical CVEs or tumours, no incidence of CVEs or tumours and no death during the four examinations) and had complete systolic blood pressure and BMI data.ResultsA total of 868 CVEs occurred. The cumulative incidence of CVEs increased as ARVSBP rose in both the normal weight and overweight groups. In same BMI groups, the risk of CVEs significantly increased as ARVSBP increased only in the normal weight group (highest quartiles of ARVSBP: HR (95% CI) 2.20 (1.46–3.31)). In the different BMI groups, the risk of CVEs in the ARVSBP subgroup in each BMI group was higher than that the least quintile of ARVSBP in the normal weight group (highest quartiles of ARVSBP in obesity: HR (95% CI) 2.28 (1.47–3.55)). The result of the competitive risk model did not change.ConclusionsAs BMI and ARVSBP increase, the risk of CVEs increases. However, the risk of visit-to-visit BPV on CVEs varies in different BMI groups, especially in people of normal weight.Trial registration numberCHiCTR-TNC1100 1489.

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Risk of cardiovascular events among women with high normal blood pressure or blood pressure progression: prospective cohort study

Yearbook of Cardiology ◽

10.1016/s0145-4145(08)05043-0 ◽

2008 ◽

Vol 2008 ◽

pp. 70-72

Author(s):

W.J. Elliott

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Cardiovascular Events ◽

Normal Blood ◽

Normal Blood Pressure

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Inter-leg systolic blood pressure difference predicts cardiovascular events and mortality in incident hemodialysis patients

The International Journal of Artificial Organs ◽

10.1177/0391398819882703 ◽

2019 ◽

Vol 43 (4) ◽

pp. 217-224

Author(s):

Sawako Kato ◽

Bengt Lindholm ◽

Abdul Rashid Qureshi ◽

Hideyuki Mukai ◽

Yukio Yuzawa ◽

...

Keyword(s):

Blood Pressure ◽

Relative Risk ◽

Confidence Interval ◽

Systolic Blood Pressure ◽

Pressure Difference ◽

Cardiovascular Events ◽

Hemodialysis Patients ◽

Cumulative Number ◽

Blood Pressure Difference ◽

Increased Risk

Background: High inter-arm blood pressure difference, a marker of vascular disease, may be difficult to assess in hemodialysis patients with arm arteriovenous fistulae. We investigated if high inter-leg systolic blood pressure difference associates with cardiovascular events and increased mortality in hemodialysis patients. Methods: Among 118 incident Japanese dialysis patients, bilateral leg blood pressure, arm blood pressure, brachial–ankle pulse wave velocity, and ankle–brachial index were measured, and the relative risk associated with inter-leg systolic blood pressure difference and other indices of vascular status was analyzed. Results: During follow-up (median, 46 months), 18 deaths and 75 cardiovascular events occurred in 38 patients. Kaplan–Meier curves showed that higher inter-leg systolic blood pressure difference was associated with overall (log-rank 9.35, p = 0.002) and cardiovascular (log-rank 5.81, p = 0.02) mortality. The period from the start of dialysis therapy to the first cardiovascular event was shorter as inter-leg systolic blood pressure difference increased (log-rank 23.7, p < 0.0001). In Cox hazard models, inter-leg systolic blood pressure difference greater than median independently predicted deaths (relative risk, 3.8; 95% confidence interval, 1.3–13.9) and cardiovascular events (relative risk, 3.9; 95% confidence interval, 1.9–9.21) after adjustments for age, sex, nutritional status, and diabetes, whereas other indices were not related to the risks. For well-nourished, moderately malnourished, and severely malnourished patients, the cumulative number of cardiovascular events in the high–inter-leg systolic blood pressure difference patients were 4.96, 31.44, and 55.18 events per 100 patient-years. Conclusions: Higher inter-leg systolic blood pressure difference associated with increased risk of mortality and cardiovascular events suggesting that wider application of inter-leg systolic blood pressure difference measurements may be warranted in hemodialysis patients.

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