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Myths and reality concerning hypertension in peritoneal dialysis patients: results of a multicenter study
Lucatello1, Cocchi, Degli Esposti E
1Department of Nephrology and Dialysis rising single quote, left (low)S. Maria delle Croci Hospital', Ravenna, Italy.
Insights
Hypertension is highly prevalent in peritoneal dialysis patients, with most receiving treatment. Despite this, blood pressure control is achieved in many, though classification as
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Peritoneal dialysis (PD) patients often experience hypertension.
- Understanding blood pressure profiles is crucial for managing cardiovascular risk in this population.
Purpose of the Study:
- To determine the prevalence of hypertension in PD patients.
- To analyze average blood pressure, 24-hour blood pressure profiles, and antihypertensive therapy efficacy.
- To investigate the diurnal blood pressure rhythm and its influencing factors.
Main Methods:
- A cross-sectional, observational multicenter study involving 414 PD patients.
- Ambulatory blood pressure monitoring (ABPM) and office blood pressure (BP) measurements were performed.
- Data analyzed using World Health Organization/International Society of Hypertension criteria and various dipping classification systems.
Main Results:
- 89.4% of PD patients were hypertensive; 82.1% were on antihypertensive therapy.
- Daytime BP was significantly lower than office BP (P < 0.001).
- A high proportion of patients were 'nondippers' (53.1%-65.0%) across different criteria; white-coat hypertension was rare.
Conclusions:
- Hypertension is common in PD patients, with white-coat hypertension being infrequent.
- Antihypertensive therapy is widely used, and BP control is achieved in many patients.
- Caution is advised when classifying PD patients as dippers or nondippers based on current criteria.
Abstract:
OBJECTIVES: To evaluate the prevalence of hypertension, the average blood pressure level, the 24 h blood pressure profile, and the efficacy of antihypertensive therapy for a large population of peritoneal dialysis patients.DESIGN: A cross-sectional, observational multicenter study. METHODS: From 504 peritoneal dialysis patients (18% of the Italian peritoneal dialysis population) involved in a multicenter observational study, we selected 414 who had undergone successful ambulatory blood pressure monitoring (i.e. no hours with data absent, >/= 75% successful readings and monitoring duration >/= 24 h). Office blood pressure measurements and ambulatory blood pressure monitoring were performed for each patient on the same day with a standard mercury sphygmomanometer and a SpaceLabs 90207 device, respectively.RESULTS: According to World Health Organization/International Society of Hypertension criteria, 44 peritoneal dialysis patients (10.6%) were normotensive and 370 patients (89.4%) were hypertensive, 304 (82.1%) of whom were being administered antihypertensive therapy. Daytime systolic and diastolic blood pressures were both significantly lower than office systolic and diastolic blood pressures (140.7 +/- 19.7/72.1 +/-11.1 versus 148.3 +/- 23.6/85.6 +/- 12 mmHg; P < 0.001). The difference between office blood pressure and daytime blood pressure was significantly correlated to office blood pressure (P < 0.001 for systolic and P < 0.001 for diastolic). The diurnal blood pressure rhythm evaluated by visual inspection of hourly mean plots was not influenced by sex, age, antihypertensive treatment, and peritoneal dialysis modality. Systolic and diastolic blood pressures exhibited a day-night mean decreases of 8.6 +/- 11.7 and 7.7 +/- 6.9 mmHg, respectively, and daytime blood pressure values were significantly higher than night-time ones (P < 0.001). Two hundred and twenty patients (53.1%) were nondippers according to O'Brien's criteria, 247 patients (59.7%) were nondippers according to Verdecchia's criteria, and 269 patients (65.0%) were nondippers according to Staessen's criteria. Only 39 patients (9.4%) had a reversed circadian rhythm. The day-night differences of systolic and diastolic blood pressures were in a unimodal distribution. Among hypertensive patients not being administered antihypertensive therapy, only six patients ( five women and one man) had white-coat hypertension. Among hypertensive patients being administered antihypertensive therapy, 235 patients (77.3%) had 24 h blood pressure loads > 30%.CONCLUSION: There is a high prevalence of hypertension among peritoneal dialysis patients. White-coat hypertension is very rare in this population. Despite the extensive use of antihypertensive therapy, control of blood pressure is maintained in a large number of our peritoneal dialysis patients. Any classification of patients into dipers and nondippers must be interpreted cautiously.