Objectives: It is well known that blood pressure (BP) exhibits BP variation in patients with hemodialysis (HD). We have previously reported that high visit-to-visit blood pressure variability is independently correlated with cardiovascular mortality in maintenance HD patients. However, the characteristics of long-term BP variability remains to be elucidated in these patients. The present study, therefore aimed to investigate the characteristics of month-by-month blood pressure variability, as an indicator of longterm blood pressure variability, and the relationship between month-by-month blood pressure variability and cardiovascular mortality in these patients. Design and method:A total of 324 maintenance HD patients, who could be followed for 60 months, were recruited. We used variation independent of the mean (VIM), which was estimated using systolic BP (SBP) in pre-dialysis and post-dialysis at the beginning of the month in 12 consecutive months (pre-VIM-SBP and post-VIM-SBP), as an index of month-by-month BP variability. We also estimated the average of 12 values of differences between the highest and lowest SBP values during a dialysis session (average D SBP) and the difference between SBP in January and February and SBP in July and August (seasonal variability of SBP).We investigated (1) the reproducibility of these values, (2) the relationship between these values and background factors, and (3) the association between these values and mortality.
Objective: Ranolazine is an anti-ischaemic agent with additional electrophysiological properties by inhibiting the cardiac late Na+ current and reducing the Ca2+ overload; it does not produce a change in heart rate or blood pressure. This study aimed to know if Ranolazine was added to Angiotensin Receptor Blockers plus Mineralocorticoid Receptor Antagonists (ARB+MRA) therapy in hypertensive with normal kidney function can reduce or avoid ventricular extrasystoles without the use of antiarrhythmics drugs such as flecainide or propafenone.Design & Methods: For developing this study, one first group of 45 hypertensive patients was entered, females 17 with an average age of 64.8 (SD 14.0) and males 28 with an average age of 68.4 (SD 12.8) in a regime of ARB+MRA therapy. All patients were assessed with a 24hs-monitoring Holter, pre and post Ranolazine (375/500 mg, 2xd), with an average therapy time-length on females-males by 12.4 (SD 10.0) -12.8 (SD 12.0) months. Also, the second group of 73 patients was registered, females-males (43-30) with an average age (SD) 67.1 (12.2) -66.8 (13.5) assessed with a 24hs-monitoring Holter only once at 12.2-16.7 months after ARB+MRA+Ranolazine therapy. All patients achieved normal levels of the central hemodynamic parameters, principally augmentation index (surrogate value of arterial stiffness) and end-systolic pressure measured with applanation tonometry (SphygmoCor System-PVX AtCor-Australia) used according to standard methods.
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