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Uncontrolled hypertension due to volume overload contributes to higher left ventricular mass index in CAPD patients
Mehmet Koc1, Ahmet Toprak, Hakan Tezcan
1Division of Nephrology, Marmara University Medical School, Istanbul, Turkey. drmkoc@yahoo.com
Insights
Uncontrolled hypertension is common in continuous ambulatory peritoneal dialysis (CAPD) patients, often linked to fluid overload. Further research is needed to explore interventions like salt restriction for better blood pressure control.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Hypertension (HT) is a significant risk factor for cardiovascular complications in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Assessing uncontrolled HT and its relationship with intravascular volume status is crucial for managing CAPD patients.
Purpose of the Study:
- To determine the prevalence of uncontrolled HT in CAPD patients using office measurements and ambulatory blood pressure monitoring (ABPM).
- To investigate the contribution of intravascular volume status, assessed by inferior vena cava diameter (IVCD) index, to elevated blood pressure (BP) and left ventricular mass index (LVMI).
Main Methods:
- Seventy-four CAPD patients were analyzed, undergoing echocardiography and ABPM.
- Patients were categorized into 'uncontrolled HT' (Group A) and 'normotensive and controlled HT' (Group B).
- Intravascular volume status was evaluated using IVCD index and collapsibility index (CI) concurrently with ABPM.
Main Results:
- The prevalence of HT was high (84% office, 82% daytime ABPM), with 73% having uncontrolled HT by ABPM.
- Patients with uncontrolled HT (Group A) had higher IVCD index and LVMI compared to Group B.
- While IVCD index correlated with BP and LVMI, 24-hour diastolic BP and hemoglobin were independent determinants of LVMI.
Conclusions:
- Uncontrolled HT is highly prevalent in volume-overloaded CAPD patients on background therapy.
- Further prospective studies are warranted to evaluate the impact of salt restriction and ultrafiltration on BP control and left ventricular hypertrophy.
Background:
Hypertension (HT) is common in patients on continuous ambulatory peritoneal dialysis (CAPD) and is responsible for increased cardiovascular morbidity and mortality. In this study, we aimed to determine the prevalence of 'uncontrolled HT' during background therapy in CAPD patients by using office measurements and ambulatory blood pressure monitoring (ABPM). We further determined whether intravascular volume status, assessed by inferior vena cava diameter (IVCD) index, contributes to higher blood pressure (BP) and increased left ventricular mass index (LVMI).
Methods:
Seventy-four CAPD patients were included in the final analysis. All patients underwent echocardiographic examination and received ABPM. Patients undergoing CAPD were categorized into two groups: 'uncontrolled HT' (Group A) and 'normotensive and controlled HT' (Group B). Intravascular volume status was determined using the IVCD index and collapsibility index (CI) on the same day as ABPM.
Results:
The prevalence of HT was 84% when using office measurements and 82% when using daytime ABPM. Daytime BP was 147/92 mm Hg by office measurements and 145/91 mm Hg by ABPM (P>0.05). The prevalence of 'uncontrolled HT' measured by ABPM was 73% (n=54). Patients with uncontrolled HT (Group A) were taking more antihypertensive medications than patients with 'normotension and controlled HT' (Group B, n=20; 1.0+/-0.8 vs 0.5+/-0.7, P=0.008). The IVCD index was higher in Group A than in Group B (9.2+/-2.1 vs 7.7+/-1.9 mm/m(2), P=0.007). There was no correlation between IVCD index and office BP, ABPM measurements or LVMI. The LVMI was also higher in Group A than in Group B (145+/-39 vs 118+/-34 g/m(2), P<0.01). Stepwise multiple regression analysis revealed that 24 h diastolic BP and haemoglobin were independent determinants of LVMI.
Conclusion:
Uncontrolled HT on background therapy is highly prevalent among volume overloaded CAPD patients. Further long-term prospective studies examining effects of salt restriction and ultrafiltration on BP control and left ventricle wall thickness are warranted.