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Masked uncontrolled hypertension in patients on maintenance hemodialysis
Wenjin Liu1, Liang Wang2, Zhuxing Sun2
1Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Insights
Masked uncontrolled hypertension (MUCH) is common in dialysis patients with controlled predialysis blood pressure, significantly increasing cardiovascular risk. This condition, associated with higher predialysis BP and antihypertensive medication use, elevates pulse wave velocity.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Masked uncontrolled hypertension (MUCH) is linked to heightened cardiovascular risk in the general population.
- Understanding MUCH prevalence and impact in dialysis patients is crucial for risk stratification.
- Dialysis patients often have controlled predialysis blood pressure (BP) but may have masked hypertension.
Purpose of the Study:
- To determine the prevalence of masked uncontrolled hypertension (MUCH) in dialysis patients.
- To investigate the association between MUCH and pulse wave velocity (PWV) in this cohort.
- To identify predictors of MUCH in patients undergoing dialysis.
Main Methods:
- Analysis of 145 dialysis patients with controlled predialysis BP from a larger cohort.
- Ambulatory BP monitoring and pulse wave velocity (PWV) measurement were performed.
- MUCH was defined using three different criteria based on daytime, nighttime, and total ambulatory BP readings.
Main Results:
- MUCH prevalence varied from 43.4% to 74.5% depending on the definition used.
- Antihypertensive medication use (OR≥4.28) and higher predialysis BP were consistent predictors of MUCH.
- Patients with MUCH exhibited significantly elevated PWV compared to those without MUCH (P≤0.03).
Conclusions:
- Masked uncontrolled hypertension affects a substantial proportion of dialysis patients with seemingly controlled predialysis BP.
- MUCH is significantly associated with increased pulse wave velocity, indicating higher cardiovascular risk.
- Higher predialysis BP and antihypertensive medication use are key indicators for potential MUCH in dialysis patients.
Abstract:
Masked uncontrolled hypertension (MUCH) has been proven to be associated with increased cardiovascular risk in the general population. We performed the current analysis to determine its prevalence in dialysis patients and its association with pulse wave velocity (PWV). From 368 participants of another cohort study, we selected 145 subjects with controlled predialysis blood pressure (BP). All subjects underwent ambulatory BP monitoring and PWV measurement. MUCH was defined as controlled predialysis BP with daytime BP⩾135/85 mm Hg (definition-1); total ambulatory BP⩾130/80 mm Hg (definition-2); and either daytime BP⩾135/85 mm Hg or nighttime BP⩾120/70 mm Hg (definition-3). The prevalence of MUCH was 43.4% (definition-1), 55.9% (definition-2) and 74.5% (definition-3). Multivariable logistic regression analysis showed that the use of antihypertensive medication was the most consistent predictor of MUCH within all 3 definitions (all odds ratio (OR)⩾4.28, P<0.001). Predialysis systolic BP (both OR>1, P⩽0.04), predialysis diastolic BP (both OR>1, P⩽0.001) and hemoglobin (both OR<1, P=0.02) were all significantly associated with MUCH in two models. Interdialytic weight gain (OR=0.52, P=0.02) was associated with MUCH under definition-2, and BMI (OR=0.86, P=0.03) was associated with MUCH under definition-3. Patients with MUCH had significantly elevated PWV compared with their counterparts according to all three definitions with or without adjusting for covariates (all P⩽0.03). In conclusion, MUCH affects a large proportion of dialysis patients with controlled predialysis BP and is associated with increased PWV. Patients on antihypertensive medications and with higher predialysis BP are more likely to have MUCH.