Visit-to-visit systolic blood pressure variability and outcomes in hemodialysis

• Published in: Journal of human hypertension Vol. 28; no. 1; pp. 18 - 24
• Main Authors: Chang, T I, Flythe, J E, Brunelli, S M, Muntner, P, Greene, T, Cheung, A K, Chertow, G M
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.01.2014; Nature Publishing Group
• Subjects: 692/699/1585/104/1586; 692/699/75/243; 692/700/565/1950/1544; 692/700/565/2194; Adolescent; Adult; Aged; Aged, 80 and over; Blood pressure; Blood Pressure - physiology; Blood Pressure Determination; Cardiovascular diseases; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Cause of Death; Epidemiology; Female; Follow-Up Studies; Health Administration; Hemodialysis; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; original-article; Patient outcomes; Physiological aspects; Public Health; Renal Dialysis; Risk Factors; Systole; blood pressure variability; hemodialysis; cardiovascular disease; end-stage renal disease; hypertension
• ISSN: 0950-9240; 1476-5527
• DOI: 10.1038/jhh.2013.49

Visit-to-visit blood pressure variability (VTV-BPV) is an independent risk factor for cardiovascular events and death in the general population. We sought to determine the association of VTV-BPV with outcomes in patients on hemodialysis, using data from a National Institutes of Health-sponsored randomized trial (the HEMO study). We used the coefficient of variation (CV) and the average real variability in systolic blood pressure (SBP) as metrics of VTV-BPV. In all, 1844 out of 1846 randomized subjects had at least three visits with SBP measurements and were included in the analysis. Median follow-up was 2.5 years (interquartile range 1.3–4.3 years), during which time there were 869 deaths from any cause and 408 (adjudicated) cardiovascular deaths. The mean pre-dialysis SBP CV was 9.9±4.6%. In unadjusted models, we found a 31% higher risk of death from any cause per 10% increase in VTV-BPV. This association was attenuated after multivariable adjustment but remained statistically significant. Similarly, we found a 28% higher risk of cardiovascular death per 10% increase in VTV-BPV, which was attenuated and no longer statistically significant in fully adjusted models. The associations among VTV-BPV, death and cardiovascular death were modified by baseline SBP. In a diverse, well-dialyzed cohort of patients on maintenance hemodialysis, VTV-BPV, assessed using metrics of variability in pre-dialysis SBP, was associated with a higher risk of all-cause mortality and a trend toward higher risk of cardiovascular mortality, particularly in patients with a lower baseline SBP.