Evaluation of blood pressure variability in maintenance hemodialysis patients_West China Medical Journal

Authors：

LIAO Ruoxi , LIN Liping , LI Jiameng ,  SU Baihai

Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

SU Baihai, Email: imsbh@163.com

Keywords：

Blood pressure variability; Maintenance hemodialysis; Cardiovascular event; Prognosis

DOI：

10.7507/1002-0179.201804086

Video：

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Blood pressure variability (BPV) refers to the fluctuations of blood pressure in a certain period of time. In recent years, BPV is becoming a predictive marker for cardiovascular events. Given the hemodynamic and internal environmental change brought by hemodialysis as well as the complex complications, hemodialysis patients always have complex BPV. Nowadays there is no consensus on an optimal standard to evaluate BPV in hemodialysis population. Metrics usually used are as follows: blood pressure change during a certain period of time, standard deviation, coefficient of variation, variation independent of mean, average real variability, weighted mean of daytime and night-time standard deviation, residual derived from generalized linear models, and residual standard deviation. Impact factors of BPV in hemodialysis patients include age, ultrafitration volume, hemodialysis frequency and time length, peripheral vascular disease, serum calcium, antihypertensive drugs and so on. Recent studies showed significant associations between both long-term and short-term BPV with prognosis of hemodialysis patients. This review focuses on the evaluation methods, the influencing factors and the impact on prognosis of BPV.

Citation： LIAO Ruoxi, LIN Liping, LI Jiameng, SU Baihai. Evaluation of blood pressure variability in maintenance hemodialysis patients. West China Medical Journal, 2018, 33(7): 905-908. doi: 10.7507/1002-0179.201804086 Copy

1.	Mills KT, Xu Y, Zhang WD, et al. A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010. Kidney Int, 2015, 88(5): 950-957.
2.	Weiner DE, Tighiouart H, Amin MG, et al. Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies. J Am Soc Nephrol, 2004, 15(5): 1307-1315.
3.	Parati G, Ochoa JE, Lombardi C, et al. Blood pressure variability: assessment, predictive value, and potential as a therapeutic target. Curr Hypertens Rep, 2015, 17(4): 537.
4.	Kuipers J, Usvyat LA, Oosterhuis JK, et al. Variability of predialytic, intradialytic, and postdialytic blood pressures in the course of a week: a study of Dutch and US maintenance hemodialysis patients. Am J Kidney Dis, 2013, 62(4): 779-788.
5.	Karpetas A, Loutradis C, Bikos A, et al. Blood pressure variability is increasing from the first to the second day of the interdialytic interval in hemodialysis patients. J Hypertens, 2017, 35(12): 2517-2526.
6.	Mallamaci F, Minutolo R, Leonardis D, et al. Long-term visit-to-visit office blood pressure variability increases the risk of adverse cardiovascular outcomes in patients with chronic kidney disease. Kidney Int, 2013, 84(2): 381-389.
7.	Abboud FM, Harwani SC, Chapleau MW. Autonomic neural regulation of the immune system: implications for hypertension and cardiovascular disease. Hypertension, 2012, 59(4): 755-762.
8.	Kim HY, Kang YU, Kim CS, et al. Association of age and BP variability with long-term mortality in hemodialysis patients. Kidney Blood Press Res, 2013, 38(2/3): 172-180.
9.	Flythe JE, Brunelli SM. Blood pressure variability among chronic dialysis patients: recent advances in knowledge. Curr Opin Nephrol Hypertens, 2015, 24(2): 163-169.
10.	Mena LJ, Felix VG, Melgarejo JD, et al. 24-Hour blood pressure variability assessed by average real variability: a systematic review and Meta-analysis. J Am Heart Assoc, 2017, 6(10): e6895.
11.	Flythe JE, Kunaparaju S, Dinesh K, et al. Factors associated with intradialytic systolic blood pressure variability. Am J Kidney Dis, 2012, 59(3): 409-418.
12.	Shafi T, Sozio SM, Bandeen-Roche KJ, et al. Predialysis systolic BP variability and outcomes in hemodialysis patients. J Am Soc Nephrol, 2014, 25(4): 799-809.
13.	Morfin JA, Fluck RJ, Weinhandl ED, et al. Intensive hemodialysis and treatment complications and tolerability. Am J Kidney Dis, 2016, 68(5S1): S43-S50.
14.	Murashima M, Kumar D, Doyle AM, et al. Comparison of intradialytic blood pressure variability between conventional thrice-weekly hemodialysis and short daily hemodialysis. Hemodial Int, 2010, 14(3): 270-277.
15.	Titapiccolo JI, Cerutti S, Garzotto F, et al. Blood pressure variability and cardiovascular autonomic control during hemodialysis in peripheral vascular disease patients. Physiol Meas, 2012, 33(4): 667-678.
16.	Wang Y, Qin Y, Fan X, et al. Variability in predialysis systolic blood pressure and long-term outcomes in hemodialysis patients. Kidney Blood Press Res, 2018, 43(1): 115-124.
17.	Sigrist MK, Taal MW, Bungay P, et al. Progressive vascular calcification over 2 years is associated with arterial stiffening and increased mortality in patients with stages 4 and 5 chronic kidney disease. Clin J Am Soc Nephrol, 2007, 2(6): 1241-1248.
18.	Jiang D, Kawagoe Y, Kuwasako K, et al. Inhibitory effects of losartan and azelnidipine on augmentation of blood pressure variability induced by angiotensin Ⅱ in rats. Eur J Pharmacol, 2017, 806: 91-95.
19.	Mitsuhashi H, Tamura K, Yamauchi J, et al. Effect of losartan on ambulatory short-term blood pressure variability and cardiovascular remodeling in hypertensive patients on hemodialysis. Atherosclerosis, 2009, 207(1): 186-190.
20.	Ito T, Fujimoto N, Ishikawa E, et al. The effect of an L/N-type calcium channel blocker on intradialytic blood pressure in intradialytic hypertensive patients. Clin Exp Hypertens, 2018: 1-8.
21.	Brunelli SM, Thadhani RI, Lynch KE, et al. Association between long-term blood pressure variability and mortality among incident hemodialysis patients. Am J Kidney Dis, 2008, 52(4): 716-726.
22.	Chang TI, Flythe JE, Brunelli SM, et al. Visit-to-visit systolic blood pressure variability and outcomes in hemodialysis. J Hum Hypertens, 2014, 28(1): 18-24.
23.	Flythe JE, Inrig JK, Shafi T, et al. Association of intradialytic blood pressure variability with increased all-cause and cardiovascular mortality in patients treated with long-term hemodialysis. Am J Kidney Dis, 2013, 61(6): 966-974.
24.	Feng Y, Li Z, Liu J, et al. Association of short-term blood pressure variability with cardiovascular mortality among incident hemodialysis patients. Ren Fail, 2018, 40(1): 259-264.

1. Mills KT, Xu Y, Zhang WD, et al. A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010. Kidney Int, 2015, 88(5): 950-957.
2. Weiner DE, Tighiouart H, Amin MG, et al. Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies. J Am Soc Nephrol, 2004, 15(5): 1307-1315.
3. Parati G, Ochoa JE, Lombardi C, et al. Blood pressure variability: assessment, predictive value, and potential as a therapeutic target. Curr Hypertens Rep, 2015, 17(4): 537.
4. Kuipers J, Usvyat LA, Oosterhuis JK, et al. Variability of predialytic, intradialytic, and postdialytic blood pressures in the course of a week: a study of Dutch and US maintenance hemodialysis patients. Am J Kidney Dis, 2013, 62(4): 779-788.
5. Karpetas A, Loutradis C, Bikos A, et al. Blood pressure variability is increasing from the first to the second day of the interdialytic interval in hemodialysis patients. J Hypertens, 2017, 35(12): 2517-2526.
6. Mallamaci F, Minutolo R, Leonardis D, et al. Long-term visit-to-visit office blood pressure variability increases the risk of adverse cardiovascular outcomes in patients with chronic kidney disease. Kidney Int, 2013, 84(2): 381-389.
7. Abboud FM, Harwani SC, Chapleau MW. Autonomic neural regulation of the immune system: implications for hypertension and cardiovascular disease. Hypertension, 2012, 59(4): 755-762.
8. Kim HY, Kang YU, Kim CS, et al. Association of age and BP variability with long-term mortality in hemodialysis patients. Kidney Blood Press Res, 2013, 38(2/3): 172-180.
9. Flythe JE, Brunelli SM. Blood pressure variability among chronic dialysis patients: recent advances in knowledge. Curr Opin Nephrol Hypertens, 2015, 24(2): 163-169.
10. Mena LJ, Felix VG, Melgarejo JD, et al. 24-Hour blood pressure variability assessed by average real variability: a systematic review and Meta-analysis. J Am Heart Assoc, 2017, 6(10): e6895.
11. Flythe JE, Kunaparaju S, Dinesh K, et al. Factors associated with intradialytic systolic blood pressure variability. Am J Kidney Dis, 2012, 59(3): 409-418.
12. Shafi T, Sozio SM, Bandeen-Roche KJ, et al. Predialysis systolic BP variability and outcomes in hemodialysis patients. J Am Soc Nephrol, 2014, 25(4): 799-809.
13. Morfin JA, Fluck RJ, Weinhandl ED, et al. Intensive hemodialysis and treatment complications and tolerability. Am J Kidney Dis, 2016, 68(5S1): S43-S50.
14. Murashima M, Kumar D, Doyle AM, et al. Comparison of intradialytic blood pressure variability between conventional thrice-weekly hemodialysis and short daily hemodialysis. Hemodial Int, 2010, 14(3): 270-277.
15. Titapiccolo JI, Cerutti S, Garzotto F, et al. Blood pressure variability and cardiovascular autonomic control during hemodialysis in peripheral vascular disease patients. Physiol Meas, 2012, 33(4): 667-678.
16. Wang Y, Qin Y, Fan X, et al. Variability in predialysis systolic blood pressure and long-term outcomes in hemodialysis patients. Kidney Blood Press Res, 2018, 43(1): 115-124.
17. Sigrist MK, Taal MW, Bungay P, et al. Progressive vascular calcification over 2 years is associated with arterial stiffening and increased mortality in patients with stages 4 and 5 chronic kidney disease. Clin J Am Soc Nephrol, 2007, 2(6): 1241-1248.
18. Jiang D, Kawagoe Y, Kuwasako K, et al. Inhibitory effects of losartan and azelnidipine on augmentation of blood pressure variability induced by angiotensin Ⅱ in rats. Eur J Pharmacol, 2017, 806: 91-95.
19. Mitsuhashi H, Tamura K, Yamauchi J, et al. Effect of losartan on ambulatory short-term blood pressure variability and cardiovascular remodeling in hypertensive patients on hemodialysis. Atherosclerosis, 2009, 207(1): 186-190.
20. Ito T, Fujimoto N, Ishikawa E, et al. The effect of an L/N-type calcium channel blocker on intradialytic blood pressure in intradialytic hypertensive patients. Clin Exp Hypertens, 2018: 1-8.
21. Brunelli SM, Thadhani RI, Lynch KE, et al. Association between long-term blood pressure variability and mortality among incident hemodialysis patients. Am J Kidney Dis, 2008, 52(4): 716-726.
22. Chang TI, Flythe JE, Brunelli SM, et al. Visit-to-visit systolic blood pressure variability and outcomes in hemodialysis. J Hum Hypertens, 2014, 28(1): 18-24.
23. Flythe JE, Inrig JK, Shafi T, et al. Association of intradialytic blood pressure variability with increased all-cause and cardiovascular mortality in patients treated with long-term hemodialysis. Am J Kidney Dis, 2013, 61(6): 966-974.
24. Feng Y, Li Z, Liu J, et al. Association of short-term blood pressure variability with cardiovascular mortality among incident hemodialysis patients. Ren Fail, 2018, 40(1): 259-264.

West China Medical Journal

Evaluation of blood pressure variability in maintenance hemodialysis patients

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