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Hypertension as a cardiovascular risk factor in end-stage renal failure

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Abstract

There is a paucity of high quality studies on the prognostic importance of arterial pressure in end-stage renal disease. Furthermore, the optimal timing for blood pressure (BP) measurements (pre- or postdialysis), and the prognostic value of 24-hour ambulatory BP monitoring in these patients remain to be established. In end-stage renal disease patients without diabetes and heart failure, predialysis systolic, diastolic, and pulse pressure are strongly and independently related to left ventricular mass, and the strength of these relationships is higher than that between the corresponding postdialysis values and left ventricular mass. Average predialysis systolic pressure (monthly average) is associated with left ventricular mass as strongly as 24-hour systolic BP, which suggests that the average routine predialysis BP taken over 1 month may be equally representative of the “true” BP (the integrated BP load) than 24-hour ambulatory BP monitoring. Mortality is U shaped in large hemodialysis databases. In the only prospective study that adequately controlled for cardiac function at baseline, it was shown that hypertension is associated with a higher risk of developing congestive heart failure, and that patients with left ventricular hypertrophy or chronic heart failure are at a much higher risk of mortality than patients without these complications. The role of arterial stiffening (pulse pressure) as a cardiovascular risk factor has been firmly established in an analysis of a very large dialysis database in the United States, and by recent studies based on direct measurements of pulse wave velocity.

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References and Recommended Reading

  1. Locatelli F, Bommer J, London GM, et al.: Cardiovascular disease determinants in chronic renal failure: clinical approach and treatment. Nephrol Dial Transplant 2001, 16:459–468. A compact review of cardiovascular risk factors in ESRD.

    Article  PubMed  CAS  Google Scholar 

  2. Pickering G: Hypertension. Causes, Consequences and Management, edn 2. Edinburgh: Churchill Livingstone; 1974.

    Google Scholar 

  3. Safar ME:Pulse pressure and cardiovascular risk. J Liban Med 2000, 48:354–355.

    CAS  Google Scholar 

  4. Franklin SS, Kahn SA, Wong ND, et al.: Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham Heart Study. Circulation 1999, 100:353–360.

    Google Scholar 

  5. Gardin JM, Arnold A, Gottdiener JS, et al.: Left ventricular mass in the elderly. The Cardiovascular Health Study. Hypertension 1997, 29:1095–1103.

    PubMed  CAS  Google Scholar 

  6. Verdecchia P, Carini G, Circo A, et al.: Left ventricular mass in essential hypertension. The MAVI study. J Am Coll Cardiol 2001, 38:1829–1835.

    Article  PubMed  CAS  Google Scholar 

  7. Celentano A, Palmieri V, Di Palma Esposito N, et al.: Relations of pulse pressure and other components of blood pressure to preclinical echocardiographic abnormalities. J Hypertens 2002, 20:531–537.

    Article  PubMed  CAS  Google Scholar 

  8. Franklin SS, Larson MG, Kahn SA, et al.: Does the relation of blood pressure to coronary heart disease change with aging? The Framingham Study. Circulation 2001, 103:1245–1249.

    PubMed  CAS  Google Scholar 

  9. Psaty BM, Furbert CD, Kuller LH, et al.: Association between blood pressure level and the risk of myocardial infarction, stroke and total mortality. The Cardiovascular Health Study. Arch Intern Med 2001, 161:1183–1192.

    Article  PubMed  CAS  Google Scholar 

  10. Kannel WB, Dawber TR, McGee DL: Perspectives of systolic hypertension: the Framingham Study. Circulation 1980, 61:1179–1182.

    PubMed  CAS  Google Scholar 

  11. Kannel WB: Vital epidemiologic clues in heart failure. J Clin Epidemiol 2000, 53:229–235.

    Article  PubMed  CAS  Google Scholar 

  12. Staessen JA, Fagard R, Thijs L, et al.: Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 1997, 350:757–764.

    Article  PubMed  CAS  Google Scholar 

  13. MacMahon S, Peto R, Cutler J, et al.: Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990, 335:765–774.

    Article  PubMed  CAS  Google Scholar 

  14. Cruickshank JM, Thorp JM, Zacharias FJ: Benefits and potential harm of lowering high blood pressure. Lancet 1987, 1:581–584.

    Article  PubMed  CAS  Google Scholar 

  15. Zager PG, Nikolie J, Brown RH, et al.: “U” curve association of blood pressure and mortality in haemodialysis patients. Kidney Int 1998, 54:561–569.

    Article  PubMed  CAS  Google Scholar 

  16. Port FK, Hulbert-Shearon TE, Wolfe RA, et al.: Predialysis blood pressure and mortality risk in a national sample of maintenance hemodialysis patients. Am J Kidney Dis 1999, 33:507–517. This study shows a U-shaped relationship between BP and mortality in dialysis patients in the United States. The results are thoroughly and soundly discussed.

    PubMed  CAS  Google Scholar 

  17. Foley RN, Parfrey PS, Harnett JD, et al.: Impact of hypertension on cardiomyopathy, morbidity and mortality in end-stage renal disease. Kidney Int 1996, 49:1379–1385.

    Article  PubMed  CAS  Google Scholar 

  18. Khattar RS, Swales JD, Dore C, et al.: Effect of aging on the prognostic significance of ambulatory systolic, diastolic, and pulse pressure in essential hypertension. Circulation 2001, 104:783–789. A very large retrospective cohort study in 782 hemodialysis facilities in the United States.

    PubMed  CAS  Google Scholar 

  19. London GM, Marchais SJ, Safar ME, et al.: Aortic and large artery compliance in end-stage renal failure. Kidney Int 1990, 37:137–142.

    PubMed  CAS  Google Scholar 

  20. London GM, Drueke TB: Atherosclerosis and arteriosclerosis in chronic renal failure. Kidney Int 1997, 51:1678–1695.

    Article  PubMed  CAS  Google Scholar 

  21. Amar J, Vernier I, Rossignol E, et al.: Nocturnal blood pressure and 24-hour pulse pressure are potent indicators of mortality in hemodialysis patients. Kidney Int 2000, 57:2485–2491. The only study dealing with the prognostic power of 24-hour ABPM in dialysis patients.

    Article  PubMed  CAS  Google Scholar 

  22. Safar ME, Blacher J, Pannier B, et al.: Central pulse pressure and mortality in end-stage renal disease. Hypertension 2002, 39:735–738.

    Article  PubMed  CAS  Google Scholar 

  23. Blacher J, Guerin AP, Pannier B, et al.: Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999, 99:2434–2439.

    PubMed  CAS  Google Scholar 

  24. Guerin AP, Blacher J, Pannier B, et al.: Impact of aortic stiffness attenuation on survival of patients in end-stage renal failure. Circulation 2001, 103:987–992. The first study showing that aortic pulse wave velocity predicts survival in dialysis patients.

    PubMed  CAS  Google Scholar 

  25. Zoccali C, Benedetto FA, Tripepi G, et al.: Nocturnal hypoxemia, night-day arterial pressure changes and left ventricular geometry in dialysis patients. Kidney Int 1998, 53:1078–1084.

    Article  PubMed  CAS  Google Scholar 

  26. Agarwal R, Lewis RR: Prediction of hypertension in chronic hemodialysis patients. Kidney Int 2001, 60:1982–1989. An elegant study testing the prediction power of predialysis and postdialysis BP.

    Article  PubMed  CAS  Google Scholar 

  27. Verdecchia P: Prognostic value of ambulatory blood pressure: current evidence and clinical implications. Hypertension 2000, 35:844–851.

    PubMed  CAS  Google Scholar 

  28. Zoccali C: Prediction of hypertension in hemodialysis patients. Kidney Int 2002, 61:1179–1181.

    Article  PubMed  Google Scholar 

  29. Conion PJ, Walshe JJ, Heinle SK, et al.: Predialysis systolic blood pressure correlates strongly with mean 24-hour systolic blood pressure and left ventricular mass in stable hemodialysis patients. J Am Soc Nephrol 1996, 7:2658–663.

    PubMed  CAS  Google Scholar 

  30. Zoccali C, Mallamaci F, Tripepi G, et al.: Prediction of left ventricular geometry by clinic, pre-dialysis and 24-h ambulatory BP monitoring in hemodialysis patients. J Hypertens 1999, 17(12 Pt 1):1751–1758. A study showing that average predialysis (1 month) BP is associated with LV mass as strongly as 24-hour systolic ABPM.

    Article  PubMed  CAS  Google Scholar 

  31. Port S, Demer L, Jennrich R, et al.: Systolic blood pressure and mortality. Lancet 2000, 355:175–180.

    Article  PubMed  CAS  Google Scholar 

  32. Schomig M, Eisenhardt A, Ritz E: Controversy on optimal blood pressure on haemodialysis: normotensive blood pressure values are essential for survival. Nephrol Dial Transplant 2001, 16:469–474.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Ospedali Riuniti, CNR Centro di Fisiologia Clinica, Via Vallone Petrara, 89124, Regio Cal, Italy

    Carmine Zoccali MD, Francesca Mallamaci MD & Giovanni Tripepi MD

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  1. Carmine Zoccali MD
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  2. Francesca Mallamaci MD
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  3. Giovanni Tripepi MD
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Zoccali, C., Mallamaci, F. & Tripepi, G. Hypertension as a cardiovascular risk factor in end-stage renal failure. Current Science Inc 4, 381–386 (2002). https://doi.org/10.1007/s11906-002-0068-4

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  • DOI: https://doi.org/10.1007/s11906-002-0068-4

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