Ambulatory central BP and arterial stiffness in patients with and without intradialytic hypertension

Abstract

Background Increased arterial stiffness is suggested to be involved in the pathogenesis of intradialytic‐hypertension (IDH). Ambulatory pulse‐wave‐velocity (PWV) is an independent predictor for all‐cause‐mortality in haemodialysis and its prognostic power is better than office PWV. This is the first study examining ambulatory central blood pressure (BP) and arterial stiffness parameters in patients with and without IDH. Methods This study examined 45 patients with IDH (SBP rise ≥10 mmHg from pre‐ to post‐dialysis and post‐dialysis SBP ≥150 mmHg) in comparison with 197 patients without IDH. All participants underwent 48‐h ABPM with Mobil‐O‐Graph‐NG; parameters of central haemodynamics, wave reflection and PWV were estimated. Results Age, dialysis vintage and interdialytic weight gain did not differ between‐groups. IDH patients had higher 48‐h cSBP (131.7 ± 16.2 vs. 119.2 ± 15.2 mmHg, p < 0.001), 48‐h cDBP (86.7 ± 12.7 vs. 79.6 ± 11.5 mmHg, p < 0.001) and 48‐h cPP (45.5 ± 10.4 vs. 39.8 ± 10.0 mmHg, p = 0.001) compared to patients without IDH. Similarly, during day‐ and nighttime periods, cSBP/cDBP and cPP levels were higher in IDH‐patients compared to non‐IDH. Forty‐eight‐hour augmentation pressure and index, but not AIx(75) were higher in IDH patients; 48‐h PWV (10.0 ± 2.0 vs. 9.2 ± 2.1 m/s, p = 0.017) was significantly higher in patients with IDH. The two study groups displayed different trajectories in central BP and PWV over the course of the recording; IDH patients had steadily high values of the above variables during the 2 days of the interdialytic‐interval, whereas non‐IDH patients showed a gradual elevation, with significant increases from the 1st to 2nd 24 h. Conclusions IDH patients have significantly higher levels of ambulatory central BP and arterial stiffness parameters and a different course over the 48‐h period compared with non‐IDH patients. Increased arterial stiffness could be a prominent factor associated with the high burden of cardiovascular disease in this population.

Association of Intradialytic Hypertension with Future Cardiovascular Events and Mortality in Hemodialysis Patients: Effects of Ambulatory Blood Pressure

“…Ambulatory BP was evaluated with the Mobil-O-Graph device (IEM, Stolberg, Germany), an automated oscillometric ABPM device previously validated for brachial BP measurement according to standard protocols [15] and that was shown to provide same values as a widely used ABPM monitor [16]. Ambulatory pulse wave velocity (PWV) was estimated via mathematical models taking into account the characteristic impedance and age and assuming a 3-element Windkessel model, as described previously [2, 17, 18]. The recording started before a mid-week dialysis session and was programmed to last for a complete standard 48-h intra- and interdialytic period.…”

Epidemiology, Pathophysiology, and Clinical Perspectives of Intradialytic Hypertension

“…As far as the clinical implications of IDHYPER are concerned, it could relate to impaired ambulatory central BP and pulse wave velocity, which are poor prognostic factors for mortality in HD [30]. Moreover, Shamir et al…”

“…As far as the clinical implications of IDHYPER are concerned, it could relate to impaired ambulatory central BP and pulse wave velocity, which are poor prognostic factors for mortality in HD [30]. Moreover, Shamir et al [23] found that IDHYPER was associated with left ventricular mass index since every 1 mm rise in Δ systolic BP during HD was associated with 0.2 g/m 2 increase in left ventricular mass index in adjusted models.…”