Blood pressure variability in hemodialysis patients: prognostic significance and treatment possibilities

A present review is devoted to the current state of the problem of blood pressure variability (BPV) in hemodialysis patients. The BPV classification and clinical significance of BPV metrics are discussed. The results of cohort and randomized studies on the high BPV influence on outcomes in hemodialysis patients, as well as on the possibilities of antihypertensive drugs in the treatment of high BPV in dialysis patients, are presented.

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Blood pressure variability and left ventricular hypertrophy in hemodialysis patients

Nephrology and Dialysis ◽

10.28996/1680-4422-2018-1-56-63 ◽

2018 ◽

Vol 20 (1) ◽

pp. 56-63 ◽

Cited By ~ 2

Author(s):

E.O. Borodulina ◽

◽

A.M. Shutov ◽

V.A. Serov ◽

◽

...

Keyword(s):

Blood Pressure ◽

Left Ventricular Hypertrophy ◽

Blood Pressure Variability ◽

Ventricular Hypertrophy ◽

Hemodialysis Patients ◽

Left Ventricular

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Faculty Opinions recommendation of Association between long-term blood pressure variability and mortality among incident hemodialysis patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718498780.793497554 ◽

2014 ◽

Author(s):

Michel Chonchol ◽

Kristen Jablonski

Keyword(s):

Blood Pressure ◽

Blood Pressure Variability ◽

Hemodialysis Patients

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A Comparative Study of Short-Term Blood Pressure Variability in Hemodialysis Patients with and without Intradialytic Hypertension

American Journal of Nephrology ◽

10.1159/000493989 ◽

2018 ◽

Vol 48 (4) ◽

pp. 295-305 ◽

Cited By ~ 5

Author(s):

Athanasios Bikos ◽

Elena Angeloudi ◽

Evangelos Memmos ◽

Charalampos Loutradis ◽

Antonios Karpetas ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Blood Pressure Variability ◽

Hemodialysis Patients ◽

Adverse Outcomes ◽

Short Term ◽

Ambulatory Bp Monitoring ◽

Average Real Variability ◽

Regular Hemodialysis ◽

Sustained Increase

Background: Short-term blood pressure (BP) variability (BPV) is associated with increased cardiovascular risk in hemodialysis. Patients with intradialytic hypertension have high risk of adverse outcomes. Whether BPV is increased in these patients is not clear. The purpose of this study was to compare short-term BPV in patients with and without intradialytic hypertension. Methods: Forty-one patients with and 82 patients without intradialytic hypertension (intradialytic SBP rise ≥10 mm Hg to > 150 mm Hg) matched in a 1: 2 ratio for age, sex, and hemodialysis vintage were included. All subjects underwent 48-h ambulatory BP monitoring during a regular hemodialysis and the subsequent interdialytic interval. Brachial and aortic BPV were calculated with validated formulas and compared between the 2 groups during the 48-h and the 44-h periods and during the 2 daytime and nighttime periods respectively. Results: During 48-h or 44-h periods and daytime or nighttime, brachial SBP/DBP and aortic SBP/DBP were significantly higher in cases than in controls. All brachial SBP/DBP BPV indexes [SD, weighted SD (wSD), coefficient-of-variation (CV) and average-real-variability (ARV)] were not significantly different between groups during the 48- or 44-h periods (48-h: SBP-ARV 11.59 ± 3.05 vs. 11.70 ± 2.68, p = 0.844, DBP-ARV: 8.60 ± 1.90 vs. 8.90 ± 1.63, p = 0.357). Analysis stratified by day or night between days 1 and 2 revealed, in general, similar results. No significant differences in dipping pattern were observed between groups. Analysis of aortic BPV had similar findings. Conclusions: BPV is similar between those with and without intradialytic hypertension. However, those with intradialytic hypertension have a sustained increase in systolic and diastolic BP during the entire interdialytic interval.

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Effect of Individualized Intervention on Home Blood Pressure and Blood Pressure Variability in Peritoneal Dialysis Patients with Hypertension

Hong Kong Journal of Nephrology ◽

10.1016/j.hkjn.2015.09.226 ◽

2015 ◽

Vol 17 (2) ◽

pp. S132

Author(s):

Ying Wang ◽

Xiang-yang Huang

Keyword(s):

Blood Pressure ◽

Peritoneal Dialysis ◽

Blood Pressure Variability ◽

Home Blood Pressure ◽

Dialysis Patients ◽

Individualized Intervention

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Abstract 16476: Visit-to-Visit Blood Pressure Variability is Associated With Incident Frailty: The Multidomain Alzheimer Preventive Trial (MAPT)

Circulation ◽

10.1161/circ.142.suppl_3.16476 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Laure Rouch ◽

Philipe de Souto Barreto ◽

Olivier Hanon ◽

Jacques Amar ◽

Yves Rolland ◽

...

Keyword(s):

Blood Pressure ◽

Standard Deviation ◽

Blood Pressure Variability ◽

Proportional Hazards ◽

Antihypertensive Drugs ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Clinical Predictors ◽

Increased Risk ◽

Preventive Trial

Introduction: Visit-to-visit blood pressure variability (BPV) has been associated with greater cardiovascular and all-cause mortality, cognitive impairment, and incident dementia. It may also represent a decline in homeostatic mechanisms in blood pressure (BP) regulation associated with frailty, one of the most problematic expression of population aging. Hypothesis: We hypothesized that visit-to-visit systolic (SBPV), diastolic (DBPV), mean arterial (MAPV) and pulse pressure (PPV) variability are associated with greater incident frailty. Methods: We included 1,394 non-frail community-dwelling participants aged ≥ 70 years from the Multidomain Alzheimer Preventive Trial (MAPT) who underwent repeated clinical examinations over a 5-year follow-up period. SBPV, DBPV, MAPV and PPV were evaluated using standard deviation, coefficient of variation (CV), average real variability, successive variation, variation independent of mean and residual standard deviation. Incident frailty was assessed using the Fried phenotype. Cox proportional hazards models were used for the analyses. Results: Higher SBPV was significantly associated with increased risk of incident frailty (1-sd increase of CV: HR = 1.18, 95% CI [1.02-1.37], p=0.03) after adjustment for demographics, body mass index, stroke, ischemic heart disease, diabetes, heart failure, antihypertensive drugs, systolic BP, MAPT intervention groups and baseline pre-frail status. Similar results were observed with all indicators of variability. DBPV and MAPV were not associated with incident frailty (p=0.6 and p=0.2, respectively). Interestingly, higher PPV was also associated with a greater risk of developing frailty over time (1-sd increase of CV: HR = 1.17, 95% CI [1.01-1.35], p=0.03). Conclusion: Independently of BP, higher SBPV and PPV are major clinical predictors of incident frailty. Our findings support the concept of BP physiological dysregulation underlying the frail state and suggest that controlling BP instability could be a promising interventional target in preventing frailty.

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