Key result
Central blood pressure did not outperform ambulatory peripheral blood pressure for predicting all-cause mortality and MACE in dialysis patients over a median follow-up of 51.5 months.
Why the study?
Although ambulatory brachial BP is considered most reliable in dialysis patients, office central BP had not been compared with ambulatory BP for risk stratification.
Does central blood pressure measurement improve prediction of mortality and cardiovascular events compared to ambulatory blood pressure in hemodialysis patients?
Cohort (n=368)
Yes
Does central blood pressure measurement improve prediction of mortality and cardiovascular events compared to ambulatory blood pressure in hemodialysis patients?
Central blood pressure does not outperform ambulatory peripheral blood pressure for predicting mortality and cardiovascular events in hemodialysis patients, supporting the continued use of ambulatory BP in this population.
Ambulatory pulse pressure may guide risk stratification in hemodialysis; leaves open whether central BP adds value in other populations or settings.
OBJECTIVE: Studies in the general population suggest that central blood pressure (BP) may be superior to peripheral BP in risk assessment. Although ambulatory brachial BP is recognized as the most reliable BP measurement in the dialysis population, there is no comparison of office central BP with ambulatory BP regarding risk stratification in these patients. METHODS: In a multicenter prospective study of dialysis patients, central BP was measured noninvasively on a midweek nondialysis day, with interdialytic ambulatory BP and predialysis BP also collected. The primary outcomes were a composite of major adverse cardiovascular events (MACE) and all-cause mortality. Agreement between central and ambulatory BP was assessed using Cohen's Kappa index and Bland--Altman plot. Linear and nonlinear Cox regression models were used to determine the association of BP parameters with outcomes. RESULTS: A total of 368 patients were recruited and 366 underwent central BP measurement. Central BP had a moderate agreement with ambulatory BP in defining hypertension (κ = 0.42) with wide limits of agreement in Bland--Altman analysis. After a median follow-up of 51.5 months, central pulse pressure, ambulatory SBP and ambulatory pulse pressure were associated with all-cause mortality, whereas all BP parameters, except for predialysis DBP, were significant predictors of MACE. However, whenever evaluated in a stepwise variable selection Cox model, only ambulatory pulse pressure, but not any central BP, was determined as the best candidate for prediction of both all-cause mortality and MACE. Nonlinear Cox models revealed no significant nonlinear trend of the association between central BP and outcomes. CONCLUSION: Central BP is predictive of all-cause mortality and cardiovascular events in dialysis patients but its prognostic value does not outperform ambulatory peripheral BP. Our data support the superiority of ambulatory BP in the dialysis population.
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A 2021 study conducted a cohort in Hemodialysis (n=368). Central blood pressure vs. Ambulatory peripheral blood pressure was evaluated on Composite of major adverse cardiovascular events (MACE) and all-cause mortality. Central blood pressure did not outperform ambulatory peripheral blood pressure for predicting all-cause mortality and MACE in dialysis patients over a median follow-up of 51.5 months.
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