Blood pressure impact on left ventricular geometry in chronic haemodialysis patients

Abstract

Abstract:Aim: Left ventricular hypertrophy in chronic haemodialysis patients is multifactorial. Our aim was to evaluate retrospectively the relationship between 24-h blood pressure monitoring and geometry and function of left ventricle (LV). Patients a methods:We examined 50 patients (men/women 33/17) treated by chronic haemodialysis (>3 months) aged 57.5 years (53-63; median, interquartile range). We measured blood pressure during 24 hours in short interdialytic period using Spacelab monitor 90217. Echocardiography was provided in short interdialytic period. Results: Left ventricular mass index signifi cantly correlated with SBP (tau-b=0.21; p=0.030; 95%CI 0.01-0.42), p=0.018; p=0.009;. SBP, DBP, MAP and PP did add a signifi cant information to the prediction of relative wall thickness. We did not fi nd any relationship between BP and left ventricular ejection fraction, left ventricular enddiastolic diameter and left atrial size. Conclusion:We found out an important 24-hour blood pressure impact on left ventricular relative wall thickness and left ventricular mass index. Left ventricular ejection fraction, left ventricular enddiastolic diameter and left atrial size were not related to 24-hour blood pressure. We did not fi nd a relationship between blood pressure and left ventricular enddiastolic diameter. From all diastolic parameters the strongest association was found between systolic blood pressure in all three phases and ratio of peak early to late diastolic fi lling velocity (Tab. 5, Ref. 19 Cardiovascular complications of haemodialysis treatment are the most common cause of increased morbidity and mortality among these patients (1). Already stage 3 chronic kidney disease patients with glomerular fi ltration rate <60 ml/min/1.73m 2 belongs to the high cardiovascular risk group (2). Echocardiography verifi ed left ventricular concentric or excentric hypertrophy is present at the beginning of haemodialysis treatment in 50-75 %, while during the next course the amount is further increasing (3). Uremic cardiomyopathy is a term used in connection with disturbed left ventricular morphology and funtion in renal failure. It is a myocardial dysfunction, which occured due to long lasting impact of hemodynamic and non-hemodynamic, with uraemia and dialysis associated risk factors. Arterial hypertension, volume overload, anaemia, uremic toxins, hyperparathyroidism and increased sympathetic activity belong to the most dominant risk factors (4). A strong relationship between left ventricular (LV) mass and blood pressure was shown also in a non-uraemic population. To confi rm this relationship in haemodialysis patients is more diffi cult due to many factors affecting LV mass. Blood pressure values obtained by ambulatory or home blood pressure monitoring provide more prognostic information on cardiovascular risk compared to blood pressure values measured during haemodialysis (5, 6).Aim of the retrospective study was to evaluate the impact of blood pressure measured by 24-hour ambulatory blood pressure monitoring (24-h A...