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Visit-to-visit systolic blood pressure variability and outcomes in hemodialysis

T I Chang1, J E Flythe, S M Brunelli

  • 1Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.

Journal of Human Hypertension
|June 28, 2013
PubMed

Insights

Visit-to-visit blood pressure variability (VTV-BPV) increases mortality risk in hemodialysis patients. Higher VTV-BPV was linked to greater all-cause mortality, especially in those with lower baseline systolic blood pressure.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Clinical Trials

Background:

  • Visit-to-visit blood pressure variability (VTV-BPV) is a known risk factor for adverse outcomes in the general population.
  • The prognostic significance of VTV-BPV in patients undergoing maintenance hemodialysis remains less understood.

Purpose of the Study:

  • To investigate the association between VTV-BPV and clinical outcomes, specifically all-cause and cardiovascular mortality, in patients on hemodialysis.
  • To evaluate VTV-BPV using coefficient of variation (CV) and average real variability in systolic blood pressure (SBP).

Main Methods:

  • Analysis of data from 1844 patients in the National Institutes of Health-sponsored HEMO study with at least three pre-dialysis systolic blood pressure measurements.
  • Calculation of VTV-BPV metrics (CV and average real variability) for each patient.
  • Survival analysis using Cox proportional hazards models, adjusting for relevant covariates.

Main Results:

  • A 10% increase in VTV-BPV was associated with a 31% higher risk of all-cause mortality in unadjusted models, remaining significant after adjustment.
  • A trend towards increased cardiovascular mortality was observed with higher VTV-BPV, though not statistically significant in fully adjusted models.
  • The association between VTV-BPV and mortality was influenced by baseline systolic blood pressure, with a stronger effect in patients with lower baseline SBP.

Conclusions:

  • Visit-to-visit blood pressure variability is an independent predictor of all-cause mortality in hemodialysis patients.
  • VTV-BPV may also be associated with cardiovascular mortality, particularly in patients with lower baseline systolic blood pressure.
  • These findings highlight the importance of monitoring blood pressure variability in hemodialysis patients for risk stratification.

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