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

Abstract The association in hemodialysis patients between long-term predialysis blood pressure variability and intradialytic cardiac hemodynamics was assessed prospectively in 1070 patients receiving maintenance hemodialysis for more than 3 months. Predialysis blood pressure variability was assessed over 1-year intervals. Outcomes included factors were intradialytic hypotension and change in rate-pressure product. The final cohort’s mean age was 59 years, and 57% were males. Greater predialysis systolic blood pressure variability was associated with an increased risk of intradialytic hypotension (adjusted hazard ratio, 1.097; 95% confidence intervals 1.055 to 1.140) and change in rate-pressure product (adjusted hazard ratio, 1.213; 95% confidence intervals 1.163 to 1.265). Results were similar when blood pressure variability was stratified by baseline systolic blood pressure. Factors associated with higher systolic blood pressure variability were older age, female sex, longer duration of dialysis, and diagnosis of diabetic nephropathy, and lower levels of serum albumin. In conclusion, greater predialysis systolic blood pressure variability among hemodialysis patients was associated with greater intradialytic cardiac hemodynamic instability. Strategies to reduce blood pressure variability might be beneficial for hemodialysis patients.

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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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Long term habitual vigorous physical activity is associated with lower visit-to-visit systolic blood pressure variability

American Journal of Hypertension ◽

10.1093/ajh/hpaa198 ◽

2020 ◽

Author(s):

Xiaoyong Xu ◽

Xianghong Meng ◽

Shin-ichi Oka

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Standard Deviation ◽

Systolic Blood Pressure ◽

Blood Pressure Variability ◽

Vigorous Physical Activity ◽

Systolic Blood Pressure Variability ◽

Average Real Variability ◽

Post Hoc

Abstract Objective Our work aimed to investigate the association between vigorous physical activity and visit-to-visit systolic blood pressure variability (BPV). Methods We conducted a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a well-characterized cohort of participants randomized to intensive (<120 mmHg) or standard (<140 mmHg) SBP targets. We assessed whether patients with hypertension who habitually engage in vigorous physical activity would have lower visit-to-visit systolic BPV compared with those who do not engage in vigorous physical activity. Visit-to-visit systolic BPV was calculated by standard deviation (SD), average real variability (ARV), and standard deviation independent of the mean (SDIM) using measurements taken during the 1-, 2-, 3-, 6-, 9- and 12-month study visits. A medical history questionnaire assessed vigorous physical activity, which was divided into three categories according to the frequency of vigorous physical activity. Results A total of 7571 participants were eligible for analysis (34.8% female, mean age 67.9±9.3 years). During a follow-up of 1-year, vigorous physical activity could significantly reduce SD, ARV, and SDIM across increasing frequency of vigorous physical activity. There were negative linear trends between frequency of vigorous physical activity and visit-to-visit systolic BPV. Conclusions Long-term engagement in vigorous physical activity was associated with lower visit-to-visit systolic BPV.

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

Terapevticheskii arkhiv ◽

10.26442/00403660.2020.04.000534 ◽

2020 ◽

Vol 92 (4) ◽

pp. 91-97

Author(s):

A. S. Tokareva ◽

N. Yu. Borovkova

Keyword(s):

Blood Pressure ◽

Clinical Significance ◽

Blood Pressure Variability ◽

Antihypertensive Drugs ◽

Prognostic Significance ◽

Hemodialysis Patients ◽

Present Review ◽

Dialysis Patients ◽

Current State ◽

Randomized Studies

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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Dose-Response Relationship Between Long-Term Blood Pressure Variability and Cognitive Decline

Stroke ◽

10.1161/strokeaha.120.033697 ◽

2021 ◽

Author(s):

Chenglong Li ◽

Yanjun Ma ◽

Rong Hua ◽

Zhenchun Yang ◽

Baoliang Zhong ◽

...

Keyword(s):

Blood Pressure ◽

Cognitive Decline ◽

Dose Response ◽

Coefficient Of Variation ◽

Blood Pressure Variability ◽

Turning Point ◽

Linear Mixed Model ◽

Response Relationship ◽

Dose Response Relationship

Background and Purpose: We aimed to test whether higher long-term blood pressure variability was associated with accelerated rate of cognitive decline and evaluate potential dose-response relationship. Methods: Original survey data from the Health and Retirement Study and the English Longitudinal Study of Ageing were used. Standardized Z score of cognitive function was the main outcome measure. Visit-to-visit blood pressure SD, coefficient of variation, and variation independent of mean were used. Linear mixed model and restricted spline were applied to assess association and explore dose-response pattern. Segmented regression was used to analyze dose-response relationship and estimate turning point. Meta-analysis using random-effects model was conducted to pool results, with I 2 used to test heterogeneity. Results: A total of 12 298 dementia-free participants were included (mean age: 64.6±8.6 years). Significant association was observed between blood pressure variability and cognitive decline. Each 10% increment in coefficient of variation of systolic and diastolic blood pressure was associated with accelerated global cognitive decline of 0.026 SD/y (95% CI, 0.016–0.036, P< 0.001) and 0.022 SD/y (95% CI, 0.017–0.027, P< 0.001), respectively. Nonlinear dose-response relationship was found ( P< 0.001 for nonlinearity), with clear turning point observed ( P< 0.001 for change in slopes). Conclusions: Higher long-term blood pressure variability was associated with accelerated cognitive decline among general adults aged ≥50 years, with nonlinear dose-response relationship. Further randomized controlled trials are warranted to evaluate potential benefits of blood pressure variability-lowering strategies from a cognitive health perspective.

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Abstract P120: Association Of Liver Transaminase Levels And Long-term Blood Pressure Variability In Military Young Males In Taiwan

Hypertension ◽

10.1161/hyp.76.suppl_1.p120 ◽

2020 ◽

Vol 76 (Suppl_1) ◽

Author(s):

Gen-min Lin ◽

Pang-yen Liu

Keyword(s):

Blood Pressure ◽

Lower Risk ◽

Blood Pressure Variability ◽

Smoking Status ◽

Linear Regression Analysis ◽

Elevated Serum ◽

Young Male ◽

Liver Transaminase ◽

Young Males

Background: Elevated serum liver transaminases (AST and ALT), highly related to metabolic disorders, are paradoxically associated with lower risk of cardiovascular disease (CVD) and mortality. Blood pressure variability (BPV), a risk factor of CVD, has not been examined the relationship with serum liver transaminase. Methods: A prospective cohort of 1,112 military males, aged 32.2 years was collected in Taiwan. Serum AST and ALT were obtained from a 12 hour-fast blood sample of each participant. BPV was assessed by standard deviation (SD) and average real variability (ARV) of systolic and diastolic blood pressure (SBP and DBP), respectively across 4 visits during the study period (2012-14, 2014-15, 2015-16, and 2016-18). Multivariable linear regression analysis was used to determine the association adjusting for age, body mass index, SBP, DBP, lipid profiles, physical activity, alcohol and smoking status. Results: In the unadjusted model, serum ALT were positively correlated with SD DBP and ARV DBP (β (SE) =0.36 (0.16) and 0.24 (0.12), respectively), and so were AST (β= 0.19 (0.08) and 0.14 (0.06), respectively). However, all the associations were insignificant with adjustments. By contrast, the associations with systolic BPV were initially insignificant in the unadjusted model. With adjustments, serum ALT were negatively correlated with SD SBP and ARV SBP (β= -0.34 (0.16) and -0.24 (0.12), respectively) and so were AST (β= -0.14 (0.07) and -0.11 (0.06), respectively). Conclusion: Our findings suggest that liver transaminase levels were negatively correlated with long-term systolic BPV in young male adults, possibly accounting for the lower risk of CVD in previous studies.

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