Blood pressure variability, hemodialysis and intradialytic hypertension
It is well known that short-term blood pressure (BP) variability (BPV) is associated with increased cardiovascular risk in hemodialysis (HD), and that patients with intradialytic hypertension have an increased risk of adverse outcomes.
However, what is not yet clear is whether BPV is increased in these patients – or not, report Greek nephrologists (Bikos A et al, A Comparative Study of Short-Term Blood Pressure Variability in Hemodialysis Patients with and without Intradialytic Hypertension, Am J Nephrol 2018;48:295-305). Their present study demonstrated that a) BPV is similar in patients with and without intradialytic hypertension, but b) patients with intradialytic hypertension have a sustained increase in systolic and diastolic BP during the entire interdialytic interval.
The study included 123 hemodialysis patients: 41 with and 82 without intradialytic hypertension (defined as intradialytic systolic blood pressure rise ≥10 mm Hg to > 150 mm Hg). All subjects underwent 48-h ambulatory BP monitoring during a regular hemodialysis and during the subsequent interdialytic interval.
The authors found that brachial systolic / diastolic blood pressure (SBP/DBP) and aortic SBP/DBP were significantly higher in cases than in controls, measured during a 48-h or 44-h period and during daytime as well as nighttime. By contrast, both groups had similar brachial SBP/DBP BPV indexes [SD, weighted SD (wSD), coefficient-of-variation (CV) and average-real-variability (ARV)] during the 48- or 44-h periods (48-h: SBP-ARV 11.59 vs. 11.70, p = 0.844, DBP-ARV: 8.60 vs. 8.90, p = 0.357). In addition, there were no significant differences in dipping pattern between groups. Similar findings were also observed regarding the results of the aortic BPV.
This study was able to demonstrate that BPV is similar between HD patients with and without intradialytic hypertension. However, patients with intradialytic hypertension have a sustained increase in systolic and diastolic BP during the entire interdialytic interval.
Link to the study: https://www.karger.com/Article/Abstract/493989