Evidence for elevated pulse pressure in patients on chronic hemodialysis: A case-control study

Tozawa, Masahiko; Iseki, Kunitoshi; Iseki, Chiho; Oshiro, Saori; Yamazato, Masanobu; Higashiuesato, Yasushi; Tomiyama, Nozomi; Tana, Takeshi; Ikemiya, Yoshiharu; Takishita, Shuichi

doi:10.1046/j.1523-1755.2002.00665.x

Cited by 34 publications

(29 citation statements)

References 27 publications

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“…Tozawa et al (14) pointed out that the power of pulse pressure to predict total mortality was more accurate than that of SBP or DBP alone. London et al (12) described the importance of pulse pressure in considering BP control, and several studies reported that pulse pressure was an independent risk factor for CVE in the general population (25)(26)(27)(28)(29) and an independent predictor of risk for mortality or CVE in longterm HD patients (13)(14)(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, several studies have reported the relationship between pulse pressure and mortality or cardiovascular events in HD patients (13)(14)(15)(16)(17). In this study, we studied in a prospective cohort whether WAB was a more useful prognostic marker in HD patients than one-point BP measurement and investigated which components of WAB were the most potent marker in evaluating the effect of hypertension on cardiovascular events (CVE) or all-cause mortality in HD patients.…”

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confidence: 99%

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Weekly Averaged Blood Pressure Is More Important than a Single-Point Blood Pressure Measurement in the Risk Stratification of Dialysis Patients

Moriya

Oka

Maesato

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: With regard to monitoring blood pressure in hemodialysis patients, it is important to define clearly the time point at which the blood pressure is measured, because the blood pressure of hemodialysis patients varies with each hemodialysis session as a result of loss of excess fluid.Design, setting, participants, & measurements: Using weekly averaged blood pressure, 96 hemodialysis patients were studied prospectively for 35 mo. All patients were followed up for cardiovascular events or death from all causes.Results: Pulse weekly averaged blood pressure and age at enrollment were significantly higher and parathyroid hormone level was significantly lower in patients with cardiovascular events compared with those without cardiovascular events; however, none of the components of pre-or postdialysis blood pressure was significantly different between patients with and without cardiovascular events. Pulse weekly averaged blood pressure, prepulse pressure, age, and human atrial natriuretic peptide were significantly higher in patients who died than in survivors. Kaplan-Meier method with a log-rank test demonstrated that survival free rate from cardiovascular events and that of all-cause mortality in patients with pulse weekly averaged blood pressure >70 mmHg were significantly lower than those in the remaining patients.Conclusions: One-point measurement of blood pressure is insufficient to evaluate hypertension and prognosis of hemodialysis patients, and weekly averaged blood pressure is a useful marker because of averaging fluctuations of blood pressure during 1 wk. Among components of weekly averaged blood pressure, pulse weekly averaged blood pressure could be a good prognostic marker of the incidence of both cardiovascular events and all-cause mortality in hemodialysis patients.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Weekly Averaged Blood Pressure Is More Important than a Single-Point Blood Pressure Measurement in the Risk Stratification of Dialysis Patients

Moriya

Oka

Maesato

et al. 2008

Clinical Journal of the American Society of Nephrology

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“…Age and diabetes were significant predictors of elevated PP in both normal subjects and hemodialysis patients. A loss of compliance in large arteries is associated with aging, as described in the previous section, and diabetes accelerates the decrease in compliance of the vessel and stiffening of arteries results in increased PP (17). PP was extremely high in the majority of 37,069 patients who were undergoing hemodialysis and were analyzed by Klassen et al (18), with fewer than 10% of patients having PP Ͻ50 mmHg.…”

Section: Pp In Ckdmentioning

confidence: 99%

“…These authors showed that 50 mmHg likely was the reference value for PP in 61,724 ambulatory unselected individuals in France. Tozawa et al (17) reported that at any MAP level, hemodialysis patients had a higher SBP and PP and lower DBP values than control subjects who had normal renal function and were matched for age, gender, diabetes, and body mass index. The PP value in the control group was similar (49 mmHg) to the PP value in the group of Asmar et al (16).…”

Section: Pp In Ckdmentioning

confidence: 99%

Role of Pulse Pressure on Cardiovascular Risk in Chronic Kidney Disease Patients

Fernández‐Fresnedo¹,

Rodrigo²,

Francisco³

et al. 2006

Journal of the American Society of Nephrology

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Epidemiologic studies have emphasized the close relationship between high BP and cardiovascular disease (CVD). Recently published prospective studies have focus on systolic and pulse pressure (PP). Systolic BP seems to be a more important factor than diastolic BP on cardiovascular and all-cause mortality in older patients. PP reflects stiffness of the large arteries and increases with age. Increasingly, PP is recognized as an independent predictor of myocardial infarction, congestive heart failure, and cardiovascular death, even in hypertensive patients who undergo successful antihypertensive drug therapy, especially in older individuals. Chronic kidney disease (CKD) is a major public health problem. The progression of kidney disease and its associated cardiovascular complications are the major causes of morbidity and mortality. This holds true for all stages of kidney disease, including ESRD that requires renal replacement therapy. C hronic kidney disease (CKD) is a worldwide public health problem. There is a rising incidence and prevalence of ESRD, with poor outcome and high cost. ESRD that requires treatment with dialysis or transplantation is the most visible outcome of CKD. However, cardiovascular disease (CVD) also frequently is associated with CKD, which is important because individuals with CKD are more likely to die of CVD than to develop ESRD (1). CVD in CKD is treatable and potentially preventable, and CKD seems to be a risk factor for CVD (2). In 1998, the National Kidney Foundation Task Force issued a report that emphasized the high risk for CVD in CKD (3). This report showed that there was a high prevalence of CVD in CKD and that mortality as a result of CVD was 10 to 30 times higher in dialysis patients than in the general population. The task force recommended that patients with CKD be considered in the highest risk group. Go et al. (4) demonstrated that reduced estimated GFR Ͻ60 ml/min per 1.73 m 2 independently predicts the risk for death and cardiovascular events in individuals with or without known CVD.Most of the traditional CVD risk factors, such as older age, diabetes, systolic hypertension, left ventricular hypertrophy, and low HDL cholesterol, are highly prevalent in CKD. Several nontraditional factors, such hyperhomocysteinemia, oxidant stress, dyslipidemia, and elevated inflammatory markers, are associated with atherosclerosis. Oxidant stress and inflammation may be the primary mediators or the "missing link" that could explain the tremendous burden of CVD in CKD (2). The purpose of this review is to show the importance of pulse pressure (PP) as clinical marker of cardiovascular risk in patients with CKD. PP as Cardiovascular Risk FactorThe principal components of BP consist of both a steady component (mean arterial pressure [MAP]) and a pulsatile component (PP). Major determinants of MAP are ventricular ejection and peripheral vascular resistance. PP, the difference between systolic BP (SBP) and diastolic BP (DBP), also is made up of two major components: One that is caused by ventri...

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“…At any mean arterial BP (MAP) level, patients on maintenance hemodialysis (MHD) have higher PP values than age-matched control subjects with normal renal function (6). Both increased arterial stiffness and PP have been associated with higher risks of cardiovascular events, all-cause mortality, and cardiovascular death in patients on MHD (7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Changes in Pulse Pressure during Hemodialysis Treatment and Survival in Maintenance Dialysis Patients

Lertdumrongluk

Streja²,

Rhee

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Pulse pressure has been shown as a risk factor for mortality in patients on maintenance hemodialysis (MHD). However, the effect of change in pulse pressure during hemodialysis on survival in a large cohort of patients on MHD has not been sufficiently investigated.Design, setting, participants, & measurements This study examined the association between time-varying D pulse pressure (postdialysis minus predialysis pulse pressure) and mortality in a cohort of 98,577 patients on MHD (July 2001-June 2006) using Cox proportional hazard models with restricted cubic splines.Results The average patient age was 62 years old; among the patients, 33% were black and 59% had diabetes. During 134,814 patient-years of at-risk time, 16,054 (16%) patients died, with 6827 (43%) of the deaths caused by cardiovascular causes. In the models including adjustment for either predialysis systolic BP or mean arterial BP, there was a U-shaped association between change in pulse pressure during hemodialysis and all-cause mortality. In the systolic BP plus case mix plus malnutrition-inflammation complex syndrome-adjusted model, large declines in pulse pressure (.-25 mmHg) and increases in pulse pressure .5 mmHg were associated with higher all-cause mortality (reference: $-5 to ,5 mmHg): hazard ratios (95% confidence intervals [95% CIs]) for change pulse pressures of ,-25, $-25 to ,-15, $-15 to ,-5, 5 to ,15, 15 to ,25, and $25 mmHg were 1.21 (95% CI, 1.14 to 1.29), 1.03 (95% CI, 0.97 to 1.10), 1.01 (95% CI, 0.96 to 1.06), 1.06 (95% CI, 1.01 to 1.11), 1.17 (95% CI, 1.11 to 1.24), and 1.15 (95% CI, 1.08 to 1.23), respectively. The U-shaped association was observed with cardiovascular death.Conclusions Modest reductions in pulse pressure after hemodialysis are associated with the greatest survival, whereas large declines or rises in pulse pressure are related to higher mortality. Trials determining how to modify pulse pressure response to improve survival in the hemodialysis population are indicated.

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Evidence for elevated pulse pressure in patients on chronic hemodialysis: A case-control study

Cited by 34 publications

References 27 publications

Weekly Averaged Blood Pressure Is More Important than a Single-Point Blood Pressure Measurement in the Risk Stratification of Dialysis Patients

Weekly Averaged Blood Pressure Is More Important than a Single-Point Blood Pressure Measurement in the Risk Stratification of Dialysis Patients

Role of Pulse Pressure on Cardiovascular Risk in Chronic Kidney Disease Patients

Changes in Pulse Pressure during Hemodialysis Treatment and Survival in Maintenance Dialysis Patients

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