Cardiovascular (CV) disease is the most important cause of morbidity and mortality among patients with chronic kidney disease particularly in those undergoing chronic hemodialysis (HD). Hypertension (HT), the most important CV risk factor is frequently present and has several particular characteristics. Our aim was to analyze characteristics of HT in our group 194 patients undergoing HD.Design and method:
In this study we have analyzed characteristics of HT and arterial stiffness (i.e. PWV) in 194 patients (118 m, 83 w; mean age 63+/-15 y). All patients were dialyzed three times a week with standard bicarbonate hemodialysis solutions and synthetic dialyzers according to the recent international guidelines. All measurements were done mid week day. Blood pressure (BP) was measured with Omron M6 (after dialysis session), ABPM using Spacelab 90207 (24 h) and PWV (before dialysis session) was determined with Arteriograph.Results:
Significant difference in BP values measured after dialysis and ABPM were found (day, night, for both systolic and diastolic BP). Only 6.6% patients were normotensive, 63.3% hypertensive, while white coat (WCH) and masked hypertension (MH) were diagnosed in 26.4% and 3.7%, respectively (no gender differences). There were no differences in BP values between men and women, but PWV > 10m/s were found more frequently in men than in women in (m vs. w 56.5% vs.39.7%;p = 0.049; 48.3% in total; 10.4 +/-1.9 vs.9.7+/-1.7;p < 0.01). In logistic regression age was the most important predictor for pathologic values of PWV. WCH had slightly higher values of PWV than normotensives (9.7 +/-2.0 vs.8.5+/-1.3; p = 0.09). PWV in MH was not different compared to the sustained HT (10.2+/-1.7). Non-dipping status was established in 45.3%, extreme dipping in 18.8%, and only 21.6% were dippers.Conclusions:
Our results confirmed significant clinical value of ABPM in patients undergoing dialysis. Determination of WCH subjects and non-dippers is of utmost importance for everyday tailoring of therapy. Increased arterial stiffness should be considered as well.