Key result
24-hour ambulatory blood pressure monitoring in elderly hemodialysis patients revealed an 81% prevalence of uncontrolled hypertension, which was significantly associated with all-cause mortality.
Why the study?
Hypertension is common and challenging in dialysis patients, but routine peri-dialytic blood pressure recordings cannot accurately diagnose hypertension or stratify cardiovascular risk.
Does 24-hour ABPM identify uncontrolled hypertension and predict mortality in elderly hemodialysis patients?
Observational (n=37)
No
Does 24-hour ABPM identify uncontrolled hypertension and predict mortality in elderly hemodialysis patients?
Absolute Event Rate: 30% vs 0%
p-value: p=0.05
24-hour ABPM in elderly hemodialysis patients frequently detects uncontrolled and masked hypertension that is missed by routine peridialytic measurements and is associated with increased mortality.
ABPM detects high uncontrolled HT and nondipping linked to mortality in elderly HD patients; leaves open whether routine use improves outcomes.
Introduction: Hypertension (HT) is a common and challenging problem in patients on dialysis. Routine peri-dialytic blood pressure (BP) recordings are unable to diagnose HT accurately and stratify cardiovascular risk. We report here an analysis of 2 years, single-center experience on 24-hour ambulatory blood pressure monitoring (ABPM) in elderly hemodialysis patients in the interdialytic period. Materials and Methods: Data of all the patients above 65 years of age undergoing hemodialysis between November 2017 and December 2019 in our hemodialysis unit and for whom 24-hour ABPM was done were collected. Demographics, clinical profile, pre- and post-dialysis BP recordings, 24-hour ABPM characteristics, and the outcome status were analyzed. Results: Of the 37 patients, 28 (75.7%) were males with a mean age of 67.73 years; 67.6% were diabetic. HT was found in all patients (100%), and uncontrolled HT was noted in 30 (81%) patients by ABPM. Patients with uncontrolled HT were also nondippers of BP (100%). A significant association was observed between nondippers and coronary artery disease (n = 27, 90%, P = 0.004). Masked HT was found in 9 (24.3%) patients with normal peridialytic BP (n = 9, 24.3%, P = 0.000). No significant difference was noted between diabetic and nondiabetic patients regarding dipping status or mortality. Among 37 patients, 9 (24.3%) died during follow-up with uncontrolled HT as a significant risk factor (P = 0.05). Conclusion: The prevalence of uncontrolled HT with blunted circadian rhythm was high as detected by ABPM in the interdialytic period among elderly hemodialysis patients and had a significant impact on mortality. Masked uncontrolled HT as measured by ABPM was not uncommon in patients with normal peridialytic BP.
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A 2021 study conducted an observational in Hypertension in hemodialysis patients (n=37). Uncontrolled hypertension detected by 24-hour ABPM vs. Controlled hypertension was evaluated on All-cause mortality (p=0.05). 24-hour ambulatory blood pressure monitoring in elderly hemodialysis patients revealed an 81% prevalence of uncontrolled hypertension, which was significantly associated with all-cause mortality.
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