Interdialytic blood pressure variability and the risk of stroke in maintenance hemodialysis patients

Area of Science:

• Nephrology
• Cardiology
• Neurology

Background:

• Visit-to-visit blood pressure variability (BPV) is linked to adverse outcomes in non-dialysis populations.
• Hypertension is highly prevalent in hemodialysis (HD) patients, necessitating investigation into stroke risk factors.
• Understanding BPV's role in HD patients is crucial for improving stroke prevention strategies.

Purpose of the Study:

• To evaluate the predictive value of visit-to-visit blood pressure variability (BPV) for stroke in hemodialysis patients.
• To investigate the association between interdialytic and intradialytic BPV and stroke incidence.
• To identify modifiable risk factors for stroke in this high-risk population.

Main Methods:

• Prospective cohort study of 151 hemodialysis patients.
• Systematic measurement of predialysis, intradialysis, and post-dialysis blood pressure at each visit.
• BPV quantified using standard deviation, coefficient of variation, ARV, and VIM; interdialytic and intradialytic variability analyzed.

Main Results:

• A significant association was found between stroke and interdialytic BPV (both systolic and diastolic predialysis).
• Low-density lipoprotein-cholesterol (LDL-C) was also identified as a significant predictor of stroke.
• High interdialytic BPV independently predicted stroke risk, irrespective of age, sex, medication, or mean BP.

Conclusions:

• Increased interdialytic blood pressure variability is a significant independent risk factor for stroke in hemodialysis patients.
• Reducing interdialytic BPV may be a more effective treatment target than managing mean BP or intradialytic BPV for stroke prevention.
• Further research is warranted to confirm the therapeutic benefit of targeting interdialytic BPV in hemodialysis patients.