Long-term predialysis blood pressure variability and outcomes in hemodialysis patients

Blood pressure variability (BPV) is significantly associated with cardiovascular diseases (CVD) and mortality in hemodialysis patients. However, the relationship between blood pressure and CVD in hemodialysis patients is complex and affected by many factors. The present study aimed to assess the association of long-term predialysis BPV with all-cause mortality and major adverse cardiovascular events (MACE). One thousand seven hundred twenty-seven patients receiving maintenance hemodialysis were recruited in nine hemodialysis centers. Predialysis BPV was assessed over 1-year intervals. Outcomes included all-cause mortality and MACE during follow-up periods. The mean age of the final cohort was 59 years, of which 57% were males. Greater predialysis systolic BPV was associated with an increased risk of all-cause mortality (adjusted hazard ratio, 1.101; 95% confidence intervals 1.064-1.140) and MACE (adjusted hazard ratio, 1.091; 95% confidence intervals 1.059-1.125). Results were similar when systolic BPV was stratified by baseline systolic blood pressure. In conclusion, greater predialysis BPV among hemodialysis patients was associated with all-cause mortality and MACE. Strategies to reduce blood pressure variability might be beneficial for hemodialysis patients.