Work

Sp557relationship Between Ambulatory Blood Pressure Monitoring, Status Fluid and Cardiac Function in Hemodialysis Patients

Year: 2019

Type: article

Abstract: INTRODUCTION: Hypertension is a cardiovascular risk factor common in hemodialysis (HD) patients, correlates with left ventricular hypertrophy. Volume overload is the main cause of hypertension in this patients. Aim: Determine the relationship between ambulatory blood pressure monitoring (ABPM), status fluid and cardiac function in HD patients. METHODS: In a cross-sectional study, 24 chronic HD underwent ABMP 44 hours. Echocardiogram was performed to assess cardiac function,. The hydration status was evaluated by bioimpedance spectroscopy (BIS) and the brain natriuretic peptide (BNP). Hypertension was defined according to the recommendations of the Eighth Joint National Committee (JNC 8), with values higher than 140/90 mmHg, which correspond to values of 135/85 mmhg in ABPM according to ESH/ESC guidelines. RESULTS: The mean age was 59.5 ± 17.6 years, Men were 62.5%. The mean daytime BP was 134 ± 25/77 ± 11 mmHg, daytime pulse pressure (PP) 56 ± 17 mmHg, mean nighttime BP 132 ± 25/73 ± 13 mmHg, night PP 57 ± 17 mmHg. 22.7% of patients had a dipper pattern. 13 patients received antihipertensive drugs, the mean of antihipertensive drugs was 1.25 ± 1.11. Patients with mean BPS (44 h), daytime > 135 mmg and nocturnal BPS > 120 mmhg had a higher predialysis BPS (147± 20 vs 125 ± 18 mmhg, 147 ± 19 vs 125 ± 18 mmhg and 145 ± 18 vs 122 ± 20 mmHg, p < 0.05, respectively). Mean BPD (44h) > 85mmhg and nocturnal BPD > 70mmhg had a lower TAPSE in echocardiogram (16.8 ± 0.17 vs 22.2 ± 3.9 and 17.9 ±2.5 vs 23.7 ± 2.7 p <0.005, respectively), which is related to dysfunction of right ventricle. Average PP (44h), daytime and nighttime levels > 50mmHg had higher fluid overload, expressed as overhydration (liters) (2.1 ± 1.1 vs 1 ± 2.2, 2.1 ± 1.1 vs -0.1 ± 2.2 and 1.9 ± 1.3 vs -0.1 ± 2.5 p <0.05, respectively), as adjusted for extracellular water (12.1 ± 5.6 vs 0.7 ± 13.7, 12.1 ± 5.6 vs 0.7 ± 13.7 and 11.14 ± 6.5 ± 0.6 ± 15.3, respectively) and higher BNP (ng / L) (922 ± 836 vs 114 ± 122, 922 ± 835 vs 114 ± 122 and 824 ± 835 vs 129 ± 130, p <0.05, respectively). The patients who received antihypertensive drug were younger (51 ± 19 vs 69 ± 11 years) had a higher mean TAD (80 ± 10 vs 69 ± 11 mmHg, p <0.05) and higher daytime BPD (83 ± 9 vs 70 ± 11mmhg, p <0.05). CONCLUSIONS: Elevated values of PAD correlate with right ventricular dysfunction. Overhydrated patients present higher pulse pressure. The dry weight adjustment can help control PP, which is a cardiovascular risk factor.

Source: Nephrology Dialysis Transplantation

DOI: 10.1093/ndt/gfz103.sp557