Nighttime ambulatory systolic blood pressure predicted mortality, with higher average nighttime SBP in patients who died (144 ± 24 mmHg) versus survivors (132 ± 22 mmHg; P<0.001).
Cohort (n=235)
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Does ambulatory blood pressure measurement better predict mortality and MACE compared to clinic blood pressure in patients on peritoneal dialysis?
Ambulatory systolic blood pressure, particularly nighttime SBP, is superior to clinic blood pressure in predicting all-cause mortality and MACE in patients on peritoneal dialysis.
valor p: p=<0.001
Objective: Ambulatory blood pressure (AMBP) complements standardized BP in managing BP of patients with CKD. However, very limited data in patients on peritoneal dialysis (PD). This observational study aims to examine the AMBP measure that best predicts outcomes in PD patients and compare that with clinic BP. Design and method: This is a prospective observational study in 235 patients (mean age: 59 ± 12, 52.3% diabetes) on PD from 3 regional hospitals with clinic BP measured twice after resting for 15 min and 24-hour home AMBP. Patients were followed prospectively for all-cause mortality, major adverse cardiovascular events (MACE), and 3-point MACE which include non-fatal myocardial infarction, non-fatal stroke, and fatal cardiovascular events (CVE). Results: Mean clinic systolic (SBP) & diastolic BP (DBP): 138 ± 19 & 78 ± 13mmHg while nighttime amb SBP & DBP: 136 ± 23 & 77 ± 12 mmHg and 24-hour amb SBP & DBP: 140 ± 19 & 80 ± 10mmHg, respectively. During follow up of 57.3 ± 27.1months, 35.3% had died, 6.4% underwent kidney transplant & 58.3% survived. Those who died had higher average (av) daytime SBP (147 ± 20mmHg) & nighttime SBP (144 ± 24mmHg) than those who survived (daytime av SBP: 138 ± 16mmHg)(P<0.001) & (nighttime av SBP: 132 ± 22mmHg)(P<0.001). Av 24-hour SBP was higher for those who died versus those who survived (P<0.001). No difference was observed in DBP whether daytime, nighttime, or 24-hour av between two groups. Significant difference was observed in daytime, nighttime & 24-hour SBP between patients who had 3-point MACE versus those without. Clinic SBP and DBP did not differentiate between patients who died versus those who survived or patients with and without 3-point MACE. Among different BP readings, nighttime SBP had highest areas under the curves in predicting all-cause mortality, 3-point MACE and acute myocardial infarction/acute coronary events. Conclusions: Ambulatory SBP is superior to Clinic SBP in predicting overall mortality and MACE risk in PD patients. Among different AMBP measures, nighttime SBP showed strongest prediction with all-cause mortality and MACE risk. This is important reference for BP target in PD patients.
Wang et al. (Fri,) conducted a cohort in Chronic kidney disease on peritoneal dialysis (n=235). Ambulatory blood pressure measurement vs. Clinic blood pressure measurement was evaluated on All-cause mortality, major adverse cardiovascular events (MACE), and 3-point MACE (p=<0.001). Nighttime ambulatory systolic blood pressure predicted mortality, with higher average nighttime SBP in patients who died (144 ± 24 mmHg) versus survivors (132 ± 22 mmHg; P<0.001).