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Blood pressure variability and cardiovascular risk assessment using machine learning clustering after arteriovenous
Christopher Montoya1, Daniel Del Castillo Rix2, Camilo Polania-Sandoval3
1DeWitt Daughtry Family Department of Surgery, Division of Vascular and Endovascular Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
Insights
High blood pressure variability (BPV) significantly increases cardiovascular risk in patients with end-stage kidney disease (ESKD) undergoing arteriovenous fistula (AVF) creation. Monitoring BPV is crucial for managing cardiovascular events in this high-risk population.
Area of Science:
- Nephrology
- Cardiology
- Data Science
Background:
- Hypertension (HTN) and blood pressure variability (BPV) are prevalent in chronic kidney disease (CKD) and end-stage kidney disease (ESKD).
- Uncontrolled HTN and high BPV significantly impact cardiovascular health in ESKD patients.
- Arteriovenous fistula (AVF) creation is a common procedure for hemodialysis access in ESKD patients.
Purpose of the Study:
- To investigate the impact of BPV on cardiovascular risk in ESKD patients post-AVF creation.
- To explore the association between BPV, age, sex, BMI, and cardiovascular risk.
- To identify distinct patient clusters based on BPV levels.
Main Methods:
- Retrospective analysis of 83 ESKD patients undergoing AVF creation (February 2019 - October 2020).
- Collection of blood pressure measurements at four time points during AVF access creation.
- Quantification of BPV using machine learning clustering techniques.
Main Results:
- Three patient clusters were identified based on BPV.
- Cluster 1 (n=28) showed high BPV (SD of 16.2 mmHg) and a 42.9% cardiovascular risk rate.
- Clusters 2 and 3 exhibited lower BPV and significantly lower cardiovascular risk rates (16.7% and 12.0%, respectively). Age, sex, and BMI did not differ significantly across clusters.
Conclusions:
- BPV is significantly associated with increased cardiovascular event risk in ESKD patients undergoing AVF creation.
- Vigilant monitoring of blood pressure fluctuations is essential in this population.
- Further research is needed to develop targeted interventions for mitigating cardiovascular risk associated with BPV.
Introduction:
Hypertension (HTN) is highly prevalent among patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), uncontrolled HTN as well as high blood pressure variability (BPV) can significantly impact cardiovascular health. This study aims to understand the impact of BPV in patients with ESKD following arteriovenous fistula (AVF) creation for hemodialysis, to better understand its association with age, sex, BMI, and cardiovascular risk.
Methods:
A retrospective analysis was conducted on 83 patients who underwent AVF creation between February 2019 and October 2020 at University of Miami Hospital. During 20 months, blood pressure measurements were collected from medical records at four different times during AVF access creation process, and BPV was quantified using machine learning clustering techniques.
Results:
The study identified three distinct clusters among the 83 patients with ESKD who underwent AVF creation. Cluster 1 (n = 28) was characterized by high blood pressure variability, with a mean systolic blood pressure standard deviation of 16.2 mmHg. This cluster exhibited a significantly higher cardiovascular risk rate of 42.9% compared to Cluster 2 (n = 30) and Cluster 3 (n = 25), which had lower variability with mean systolic blood pressure standard deviations of 10.3 and 8.7 mmHg, respectively, and cardiovascular risk rates of 16.7% and 12.0%. Age, sex, and BMI did not differ significantly across the clusters.
Conclusion:
This study underscores the association between blood pressure variability and the increased risk of cardiovascular events, including myocardial infraction, stroke or heart failure in patients with ESKD undergoing AVF creation. Our findings highlight the critical need for vigilant monitoring of blood pressure fluctuations in this population and demonstrate how these variations are influenced by individual demographic factors. Further research is needed to develop targeted interventions to mitigate this risk.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.