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Volume-associated ambulatory blood pressure patterns in hemodialysis patients.
1Veterans Affairs Medical Center, 111N, 1481 West 10th St, Indianapolis, IN 46202, USA. ragarwal@iupui.edu
Hypertension (Dallas, Tex. : 1979)
|June 17, 2009
Summary
Volume overload in hemodialysis patients creates a distinct blood pressure pattern. Augmented volume removal therapy reduced this pattern but did not restore normal circadian blood pressure rhythms.
Area of Science:
- Nephrology
- Hypertension Research
- Chronobiology
Background:
- Volume excess is a known cause of hypertension in hemodialysis patients.
- The effect of volume overload on arterial pressure circadian patterns in this population is not well understood.
- Ambulatory blood pressure monitoring (ABPM) is crucial for assessing blood pressure (BP) patterns.
Purpose of the Study:
- To investigate the association between volume overload and a unique blood pressure (BP) signature in hemodialysis patients.
- To analyze the impact of augmented volume removal therapy on BP chronobiology.
- To identify the characteristic BP pattern associated with volume overload.
Main Methods:
- A posthoc analysis of 145 patients from the Dry-Weight Reduction in Hypertensive Hemodialysis Patients trial.
- Utilized 400 ABPM recordings (35,302 measurements) over 8 weeks.
- Employed the trended cosinor model to describe BP chronobiology.
Main Results:
- The trended cosinor model identified a "volume-overload BP pattern" characterized by an elevated intercept and blunted slope.
- Augmented volume removal therapy reduced the BP intercept and increased the rate of BP rise but did not alter BP fluctuation amplitude.
- This therapy did not restore normal circadian dipping or affect wake/sleep BP patterns, though it reduced pulse pressure.
Conclusions:
- An elevated intercept and blunted slope on ABPM define the "volume-overload BP pattern" in hemodialysis patients.
- Augmented volume removal therapy modifies this pattern and reduces pulse pressure.
- Further randomized trials are needed to assess the clinical impact of this therapy on hard outcomes and survival.
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