Abstract: FR-PO566

Short-Term Blood Pressure Variability Predicts Cardiovascular Events and All-Cause Mortality Better Than Office and Ambulatory Blood Pressure in Hemodialysis Patients

Session Information

Category: Hypertension

  • 1104 Hypertension: Clinical and Translational - Salt and Hypertension

Authors

  • Sarafidis, Pantelis, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • Papagianni, Aikaterini A., Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • Loutradis, Charalampos, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • Karpetas, Antonios, Hemodialysis Unit, Thessaloniki, Greece
  • Tzanis, George, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • Koutroumpas, Georgios, Achillopouleion General Hospital, Volos, Greece
  • Bikos, Athanasios, Pieria , Katerini, Greece
  • Raptis, Vasilios, Pieria , Katerini, Greece
  • Syrganis, Christos, Achillopouleion General Hospital, Volos, Greece
  • Liakopoulos, Vassilios, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
Background

Hemodialysis patients are subjected to severe blood pressure (BP) fluctuations during intra- and interdialytic periods. Long-term predialytic BP variability (BPV) is associated with increased cardiovascular risk. This is the first study to examine the prognostic significance of short-term BPV using ambulatory blood pressure monitoring (ABPM) in hemodialysis.

Methods

170 patients underwent 48h ABPM during dialysis and a standard interdialytic interval and were followed for 28±11 months. BPV parameters calculated were: standard deviation(SD), weighted SD(wSD), coefficient of variation(CV), average real variability(ARV). The primary end-point was: combination of all-cause death, non-fatal MI or stroke. Secondary end-points were: (i) all-cause death (ii) cardiovascular death (iii) combination of cardiovascular death, MI, stroke, resuscitation after cardiac arrest, coronary revascularization or hospitalization for HF.

Results

In total, 37(21.8%) patients died and 46(27.1%) had cardiovascular events. Freedom from primary end-point was similar for quartiles of predialysis SBP, 48h SBP, and SBP-SD, but was progressively shorter for SBP-wSD (p=0.03), SBP-CV (p=0.047), and SBP-ARV (81.4%, 81.0%, 73.8%, 51.2% p=0.001; Figure 1). Hazard Ratios for all outcomes were similar for quartiles of pre-dialysis SBP and 48h SBP but were progressively increasing with higher quartiles of 48h SBP-ARV (for primary outcome: Q1:reference; Q2:1.11, 95%CI:0.42-2.95; Q3:1.64, 95%CI:0.66-4.09; Q4:3.45, 95%CI:1.53-7.81).

Conclusion

Short-term BPV is associated with future cardiovascular events and mortality in hemodialysis patients,but office and ambulatory BP are not. These results add to evidence suggesting that BPV is independent cardiovascular risk factor in hemodialysis.