Sex differences in ambulatory blood pressure levels, control and phenotypes of hypertension in hemodialysis patients

Abstract

Background and aims:Ambulatory blood pressure (BP) control is worse in men than women with chronic kidney disease or kidney transplantation. So far, no study investigated possible sex differences in the prevalence, control, and phenotypes of BP according to predialysis and 48-h ambulatory blood pressure monitoring (ABPM) in hemodialysis patients. Further, no study has evaluated the diagnostic accuracy of predialysis BP in male and female hemodialysis patients.Method:One hundred and twenty-nine male and 91 female hemodialysis patients that underwent 48-h ABPM were included in this analysis. Hypertension was defined as: (1) predialysis SBP ≥140 or DBP ≥90 mmHg or use of antihypertensive agents, (2) 48-h SBP ≥130 or DBP ≥80 mmHg or use of antihypertensive agents.Results:Predialysis SBP did not differ between groups, while DBP was marginally higher in men. 48-h SBP (137.2 ± 17.4 vs. 132.2 ± 19.2 mmHg, P = 0.045), DBP (81.9 ± 12.1 vs. 75.9 ± 11.7 mmHg, P < 0.001) and daytime SBP/DBP were higher in men. The prevalence of hypertension was not different between groups with the use of predialysis BP or 48-h ABPM (92.2% vs. 89%, P = 0.411). However, concordant lack of control was more frequent in men than women (65.3% vs. 49.4%, P = 0.023). The prevalence of white-coat and masked hypertension did not differ between groups; the misclassification rate with the use of predialysis BP was marginally higher in women. In both sexes, predialysis BP showed low accuracy and poor agreement with ABPM for diagnosing ambulatory hypertension [area-under-the-curve in receiver-operating-curve analyses (SBP/DBP): men, 0.681/0.802, women: 0.586/0.707].Conclusion:Ambulatory BP levels are higher in male than female hemodialysis patients. Although hypertension prevalence is similar between sexes, men have worse rates of control. The diagnostic accuracy of predialysis BP was equally poor in men and women.

Gender-Related Differences in the Levels of Ambulatory BP and Intensity of Antihypertensive Treatment in Patients Undergoing Peritoneal Dialysis

“…In addition, the intensity of antihypertensive treatment, such as the average number of prescribed BP-lowering medications as well as the use of calcium channel blockers and β-blockers, was greater in the male PD patients than in the female PD patients. The findings of the present study are accordant with the results of a prior cross-sectional analysis that compared the rates of ambulatory BP control between 129 male and 91 female patients receiving maintenance hemodialysis [ 11 ]. In this study, the 48 h ambulatory systolic BPs (137.2 ± 17.4 vs. 132.2 ± 19.2 mmHg, p = 0.045) and 48 h ambulatory diastolic BPs (81.9 ± 12.1 vs. 75.9 ± 11.7 mmHg, p < 0.001) were higher in men than in women [ 11 ].…”

“…The findings of the present study are accordant with the results of a prior cross-sectional analysis that compared the rates of ambulatory BP control between 129 male and 91 female patients receiving maintenance hemodialysis [ 11 ]. In this study, the 48 h ambulatory systolic BPs (137.2 ± 17.4 vs. 132.2 ± 19.2 mmHg, p = 0.045) and 48 h ambulatory diastolic BPs (81.9 ± 12.1 vs. 75.9 ± 11.7 mmHg, p < 0.001) were higher in men than in women [ 11 ]. Although the prevalence of hypertension did not differ between the two genders, the rates of 48 h ambulatory BP control were significantly lower in the male hemodialysis patients than in the female hemodialysis patients [ 11 ].…”

“…In this study, the 48 h ambulatory systolic BPs (137.2 ± 17.4 vs. 132.2 ± 19.2 mmHg, p = 0.045) and 48 h ambulatory diastolic BPs (81.9 ± 12.1 vs. 75.9 ± 11.7 mmHg, p < 0.001) were higher in men than in women [ 11 ]. Although the prevalence of hypertension did not differ between the two genders, the rates of 48 h ambulatory BP control were significantly lower in the male hemodialysis patients than in the female hemodialysis patients [ 11 ]. Similarly, another prior cross-sectional study showed that among kidney transplant recipients, the rates of 24 h ambulatory BP control were significantly lower in the female patients as compared with the male patients (16.9 vs. 30.3%, p = 0.029), despite the more intensive use of antihypertensive drug therapy in the men [ 12 ].…”

Sex disparities in mortality and cardiovascular outcomes in chronic kidney disease

“…On the other hand, ambulatory BP assessments disclose the high prevalence of ‘white coat’ and ‘masked’ hypertension in CKD populations [ 68 ], and demonstrate stronger associations with CKD progression, CVD morbidity and mortality (particularly nighttime BP or short-term BP variability) compared with office BP [ 69 , 70 ]. Sex differences do exist in ambulatory BP measurements in dialysis and transplantation patients [ 71 , 72 ]; men with CKD (stages 2–5) have higher daytime and nighttime systolic BP than women, which may be the key contributor to male higher risk of adverse outcomes [ 73 ].…”