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Abstract: FR-PO842

Effects of Blood Pressure Variability on Mortality in Chronic Hemodialysis Patients: OCTOPUS Study

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Adachi, Takayuki, Tomishiro Central Hospital, Tomigusuku city, Japan
  • Kohagura, Kentaro, University of the Ryukyus, Nishihara-cho, OKINAWA, Japan
  • Arima, Hisatomi, Fukuoka Uniuversity, Fukuoka, Japan
  • Iseki, Kunitoshi, Tomishiro Central Hospital, Tomigusuku city, Japan
Background

We examined the relationship between blood pressure variability and survival among chronic HD patients.

Methods

We previously reported the results of the multi-center prospective, open trial of the Olmesartan Clinical Trial in Okinawa Patients Under Okinawa Dialysis Study (OCTOPUS). In a multicenter, prospective, randomized, open label, blinded-endpoint trial, 469 patients with chronic HD and elevated BP (140–199/90–99 mmHg) were assigned to receive the angiotensin receptor blockade (ARB) olmesartan (at a dose of 10–40 mg daily; n = 235) or another treatment that does not include angiotensin receptor blockers and angiotensin-converting enzyme (ACE) inhibitors (n = 234).
For this study, we examined of 435 patients after excluding those who died within 1 year after registration (N=28) and lack of blood pressure data for more than 2 time (N=6). We adopted the coefficient of variation (CV), which was obtained using 6 pre-HD blood pressure within the first year after registration, as a marker of blood pressure variability. Cox proportional hazard analysis was used to examine the relationship between blood pressure variability and mortality after the 1-year visit with adjustment for age, sex, smoking, DM, HD vintage, and use of angiotensin receptor blockade.

Results

During the mean follow-up of 2.5 years after the 1-year visit, we observed 58 deaths. We used five quintile groups of CV pre-HD systolic blood pressure (Q1 to Q5). The mortality rate was 9.2% (Q1), 12.8% (Q2), 9.1% (Q3), 16.1% (Q4), and 19.5% (Q5), respectively. The adjusted hazard ratio (95% confidence interval) was 1.83 (0.73-4.63) in Q1, 1.83 (0.73-4.63) in Q2, 1.84 (0.77-4.40) in Q4, and 2.42 (1.04-5.62) in Q5 when the Q3 was taken as reference.

Conclusion

Mortality rate was higher among patients with higher pre-HD variability of blood pressure.