Peridialytic and Home Blood Pressure in Relation to Left Ventricular Geometry in Hemodialysis Patients

Introduction In hemodialysis, the blood pressure measure that best reflects the chronic blood pressure burden related to left ventricular remodeling remains uncertain. We compared the associations of peridialytic and home blood pressure with left ventricular mass, left ventricular hypertrophy, and left ventricular geometry in maintenance hemodialysis patients. Methods In this multicenter cross‐sectional study, 265 adults on thrice‐weekly hemodialysis underwent 1‐week predialysis, intradialytic, postdialysis blood pressure and home blood pressure monitoring. Echocardiograms interpreted by readers blinded to blood pressure data assessed left ventricular mass index, relative wall thickness, left ventricular hypertrophy, left ventricular concentricity, and concentric left ventricular hypertrophy. Associations were evaluated using multivariable linear and logistic regression, with models adjusted for relevant clinical covariates. Findings Predialysis, intradialytic, postdialysis, and home blood pressure were 147/77 ± 24/13, 142/75 ± 22/12, 144/75 ± 23/14, and 132/79 ± 22/12 mmHg. Left ventricular hypertrophy, left ventricular concentricity, and concentric left ventricular hypertrophy were present in 48%, 38%, and 25%, respectively. Systolic home blood pressure showed the strongest association with left ventricular mass index ( β = 0.278; R 2 = 0.113; p < 0.001), whereas systolic predialysis blood pressure showed the strongest association with relative wall thickness ( β = 0.211; R 2 = 0.116; p = 0.002). In logistic regression analyses, home blood pressure was the blood pressure approach most consistently associated with left ventricular hypertrophy, left ventricular concentricity, and concentric left ventricular hypertrophy, with odds ratios ranging from 1.030 to 1.048. Discussion In maintenance hemodialysis patients, home blood pressure was more consistently associated with adverse left ventricular remodeling, particularly left ventricular mass index, left ventricular hypertrophy, and concentric left ventricular hypertrophy, whereas predialysis systolic blood pressure showed the strongest association with relative wall thickness. The associations observed for selected peridialytic blood pressure measurements support a complementary role for home and dialysis‐unit blood pressure assessment in evaluating left ventricular remodeling in this population.