Key result
Intradialytic hypertension patients exhibited a significantly different 1-24 hour post-dialysis blood pressure slope compared to hemodialysis controls (+0.1 vs +0.6 mmHg/hr; p=0.002).
Why the study?
Do interdialytic blood pressure patterns differ between patients with intradialytic hypertension and hemodialysis controls?
Case-Control (n=49)
Yes
Do interdialytic blood pressure patterns differ between patients with intradialytic hypertension and hemodialysis controls?
Patients with intradialytic hypertension have persistently elevated post-dialysis blood pressure that contributes to an overall increased blood pressure burden compared to hemodialysis controls.
Answers are grounded in this paper and cite their sources.
May signal greater interdialytic BP burden in intradialytic hypertension; leaves open whether targeted monitoring improves outcomes.
BACKGROUND/AIMS: Intradialytic hypertension (IH) patients have higher mortality risk than other hemodialysis patients and have been shown to have higher ambulatory blood pressure (BP). We hypothesized that interdialytic BP patterns would differ in IH patients and hypertensive hemodialysis controls. METHODS: We consecutively screened hemodialysis patients at our university-affiliated units. Based on pre and post-HD BP measurements during the prior 2 week period, we identified IH patients and demographically matched hemodialysis controls. We measured ambulatory interdialytic BP, flow-mediated vasodilation, and intradialytic endothelin-1 (ET-1). Using linear mixed-models, we compared BP slopes during the following intervals: 1-24 hours post-dialysis, 25-44 hours post-dialysis, and 1-44 hours post-dialysis. RESULTS: There were 25 case subjects with IH and 24 controls. Systolic BP during hours 1-44, 1-24, and 25-44 were 143.1 (16.5), 138.0 (21.2), and 150.8 (22.3) mmHg in controls. For IH subjects, they were 155.4 (14.2), 152.7 (22.8), and 156.5 (20.8) mmHg (p=0.008, 0.02, 0.4). In controls, the slopes were +0.6, +0.6, and +0.4 mmHg/hr. In IH subjects, they were +0.1, -0.3, and +0.3 mmHg/hr. The IH 1-24 hour slope differed from the IH 25-44 hour slope (p=0.001) and the control 1-24 hour slope (p=0.002). The change in ET-1 from pre to post dialysis was 0.5 (1.5) pg/mL in controls and 1.0 (2.3) pg/mL in IH patients (p=0.4). In a univariate model, there was an association with screening BP and BP slope (p=0.002 for controls and p=0.1 for IH patients). CONCLUSIONS: Interdialytic BP patterns differ in IH patients and hemodialysis controls. The elevated post dialysis blood pressure persists for many hours in IH patients contributing to the overall increased BP burden.
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Hompesch et al. (2016) conducted a case-control in Intradialytic hypertension (n=49). Intradialytic hypertension vs. Hemodialysis controls was evaluated on 1-24 hour post-dialysis systolic blood pressure slope (mmHg/hr) (p=0.002). Intradialytic hypertension patients exhibited a significantly different 1-24 hour post-dialysis blood pressure slope compared to hemodialysis controls (+0.1 vs +0.6 mmHg/hr; p=0.002).
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