[PP.28.01] AMBULATORY BLOOD PRESSURE MONITORING IN DIALYSIS PATIENTS

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Abstract

Objective:

Hypertension is a common illness among hemodialysis (HD) patients. It is frequently accompanied by other conditions such as hypertrophy of the left ventricle, increased parathyroid hormone, overhydration and disorders of the renin-angiotensin system and the sympathetic nervous system, which contribute to higher mortality.

Design and method:

We retrospectively analyzed 89 patients on HD, 42.7% of which had diabetes. Ambulatory blood pressure was monitored on the day before dialysis. Hypertension was defined as blood pressure above 140/90 mmHg. Daily rhythms of blood pressure, mean arterial pressure and pulse pressure were also measured. The control group consisted of 89 patients from the hypertension clinic who weren’t undergoing dialysis, among which 39.1% had diabetes.

Results:

All HD patients median blood pressure was 150/88 mmHg. Dip per day was −0.5%, while dip per night was −2.0%. Mean arterial pressure was 109 mmHg. Average pulse pressure was 62 mmHg. Among HD patients with diabetes 1 (3%) was a dipper, 10% were non-dippers and 71% were inverse dippers. Control group patients median blood pressure was 140/86. Dip per day was −6.2%, dip per night was −10.3%, mean arterial pressure was 104 mmHg and pulse pressure was 53 mmHg. 17% were dippers, 58% were non-dippers, and 25% were inverse dippers. Pulse pressure was significantly higher among HD patients which could have had an effect on increased afterload and decreased coronary perfusion pressure. Besides diabetes, other factors have an impact on inverse blood pressure during night time among HD patients, such as retention of extracellular fluid.

Conclusions:

Hypertension is a major risk factor of morbidity and mortality among HD patients. Causes of hypertension differ. Target blood pressure is similar to that of the general population, and lower values of blood pressure is associated with higher mortality. HD patients have a smaller decline in blood pressure during night time. Inverse values of blood pressure during the night wasn’t only among patients with diabetes.

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