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Blood Pressure and Mortality in the 4D Study
Babak Yazdani1, Marcus E Kleber1,2, Graciela E Delgado1,3
1Fifth Department of Medicine, University Medical Center Mannheim UMM, Faculty of Medicine of the University of Heidelberg, Mannheim, Germany.
Kidney & Blood Pressure Research
|October 8, 2023
Summary
Blood pressure parameters like pulse pressure (PP) do not predict mortality in dialysis patients with diabetes. However, a U-curve for PP suggests optimal ranges for cardiovascular mortality risk.
Area of Science:
- Nephrology
- Cardiology
- Diabetology
Background:
- Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) are established cardiovascular mortality (CVM) risk factors.
- Pulse pressure (PP), a measure of vascular stiffness, has unclear prognostic value for CVM in diabetic patients undergoing chronic dialysis.
Purpose of the Study:
- To investigate the predictive value of baseline predialytic blood pressure parameters (PP, SBP, DBP, MAP) for CVM in patients with type 2 diabetes on hemodialysis.
Main Methods:
- Prospective, randomized, double-blind trial (German Diabetes and Dialysis [4D] study) involving 1,255 patients.
- Analysis of baseline PP, SBP, DBP, and MAP as continuous variables and in tertiles.
- Adjustment for age and sex in mortality prediction models.
Main Results:
- Individually, PP, MAP, SBP, and DBP did not significantly predict cardiovascular or all-cause mortality when analyzed as continuous variables or in tertiles.
- A U-shaped curve was observed for PP concerning both all-cause mortality and CVM, with the lowest risk in the 70-80 mm Hg range.
Conclusions:
- Predialytic blood pressure parameters at study entry are not significant predictors of mortality in end-stage renal disease patients with long-standing diabetes mellitus.
- High rates of competing mortality risk factors may overshadow the impact of blood pressure control in this population.
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