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Blunted nocturnal blood pressure decrease and left-ventricular mass in hypertensive hemodialysis patients.

Riccardo M Fagugli1, Giuseppe Quintaliani, Paolo Pasini

  • 1Nephrology-Dialysis, Silvestrini Hospital, Perugia, Italy. rmfag@tin.it

Nephron
|May 22, 2002
PubMed
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In hypertensive hemodialysis patients, most are non-dippers, but this classification doesn't significantly impact blood pressure or left ventricular mass. Volume overload is the primary driver of left ventricular hypertrophy in this population.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Research

Background:

  • Left-ventricular hypertrophy (LVH) is a common complication in hemodialysis (HD) patients.
  • Hypertension is a major risk factor for cardiac morbidity in HD patients, with many exhibiting a blunted nocturnal blood pressure (BP) decrease (non-dippers).
  • Previous studies in essential hypertensives suggest non-dippers have higher cardiac events and left ventricle (LV) mass, but results are conflicting in dialysis patients.

Purpose of the Study:

  • To investigate differences in LV mass between dipper and non-dipper hypertensive HD patients.
  • To assess the relationship between BP patterns, LV mass, and extracellular water distribution in HD patients.

Main Methods:

  • 24-hour ambulatory BP monitoring was conducted on HD and inter-HD days for 66 hypertensive HD patients.

Related Experiment Videos

  • Patients were classified as dippers (≥10% nocturnal systolic BP decrease) or non-dippers.
  • Echocardiography and bioimpedance were used to assess LV mass index (LVMi) and extracellular water (ECW) distribution.

    • Main Results:

    • 71% of patients were classified as non-dippers.
    • No significant differences in 48-hour systolic and diastolic BP or LVMi were observed between dipper and non-dipper groups.
    • A strong correlation was found between ECW percentage and LVMi (r = 0.53, p < 0.001), while BP parameters did not correlate with LVMi.

    Conclusions:

    • The non-dipper status in hypertensive HD patients is not associated with significantly different 48-hour BP or LV mass compared to dippers.
    • Volume overload, indicated by ECW, appears to be the primary independent determinant of LVH in this patient cohort.
    • Clinical management should focus on volume status to address LVH in hypertensive HD patients.