SP562PARAMETERS OF BLOOD PRESSURE & CHRONIC HEART FAILURE IN HEMODIALYSIS PATIENTS

Abstract

INTRODUCTION AND AIMS: The CRIC Study [Kidney Int. 2016 Dec; 90(6):1348- 1356] showed that pulse blood pressure (PP) was associated with chronic heart failure (CHF) in patients with estimated glomerular filtration rate <30 ml/min/1.73 m2 & not on dialysis. The aim of this study was to evaluate the relationship between blood pressure parameters & CHF in hemodialysis patients. METHODS: Hemodialysis patients (n=63, 31 males, 32 females, mean age was 53±13 years) with dialysis period 1 year & more in one dialysis department were studied. Chronic heart failure with preserved left ventricular ejection fraction (LVEF ≥50%) was diagnosed in 25 patients & 2 pts had LVEF<50%. Pre-dialysis systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP) & post-dialysis SBP, DBP, PP & variability blood pressure parameters were studied. Self-measured home morning & evening blood pressure was obtained within 4 weeks. 24 hours blood pressure monitoring (ABPM) was performed the next day after hemodialysis. Blood pressure variability of office pre- & post-dialysis, home & ABPM parameters was assessed. Echocardiography was performed & LVMI was calculated. LVEF was measured by the echocardiographic Simpson method. Diastolic parameters were determined by tissue Doppler echocardiography. RESULTS: Arterial hypertension (mean 24 h BP > or =135 & 85 mm Hg) was diagnosed in 25 (40%) patients. The number of non-dipper patients was 36 (57%) for SBP & 24 (38%) for DBP. Left ventricular hypertrophy was detected in 41 (65%) patients. Patients with CHF had lower 24 hours DBP (P<0.001), higher PP (P=0.007), but SBP did not differ (P=0.5). Self-measured mean DBP was significantly lower in patients with CHF (morning DBP 75.0±9.1 vs 86.0±11.3 mmHg, P<0.001 & evening DBP 73.8±10.9 vs 84.4±8.4 mmHg, P<0.001). Multiple regression analysis in which independent variables were age, gender, LVMI, hemoglobin, diabetes, myocardial infarction in the past & self-measured mean morning & evening DBP shown that self measured mean morning & evening DBP were negatively independently associated with CHF (Beta = - 0.62, p=0.001 & Beta = - 0.56, p=0.003, resp.), hemoglobin & LVMI had positive independent association. In multivariate logistic regression analysis, DBP< 80 mmHg increased risk CHF, odds ratio 1.16 (95% CI 1.06-1.27) for self measured mean morning DBP & 1.16 (95% CI 1.05-1.28) for evening DBP. The correlation between office DBP & CHF was not detected. Hypotension time index & hypotension area under curve of SBP, DBP & reduce of the degree of night fall of SBP & DBP on off dialysis day were associated with CHF in simple correlation only. CONCLUSIONS: Self-measured mean morning & evening diastolic blood pressure obtained within 4 weeks negatively independently are associated with chronic heart failure stronger than 24 home blood pressure monitoring parameters the next day after hemodialysis including mean pulse pressure, diastolic blood pressure, hypotension time index & hypotension area under curve of SBP, DBP & reduce of the degree of night fall of SBP & DBP.