title: Diurnal variation of blood pressure; reproducibility and association with left ventricular hypertrophy in hemodialysis patients.
abstract: OBJECTIVE
  The objective of this paper is to describe the pattern of diurnal blood pressure (BP) change in hemodialysis patients, determine the association of the non-dipping pattern of diurnal BP with left ventricular mass index (LVMI), and to determine if the nocturnal profile of BP is reproducible when repeated over time.
  
  
  METHODS
  In a cross-sectional study, ambulatory blood pressure monitoring (ABPM) was performed over a midweek 44-h period and echocardiography was performed on the interdialytic day. Patients with a night/day systolic and diastolic BP ratio on both days >0.9 were defined as non-dippers. Ambulatory blood pressure monitoring was repeated at 6 and 12 months follow-up.
  
  
  RESULTS
  Of the 59 patients, 88% were African-American, and 48% were non-dippers. Mean LVMI was significantly higher in the non-dipper (68.3+/-25 g/height) compared to the dipper patients (55.6+/-16, P<0.05). Mean nocturnal systolic BP (r=0.35) and the night/day systolic BP ratio (r=0.39) had a higher correlation with M-mode LVMI than pre-dialysis (r=0.32). After adjustment for 44-h mean SBP, night/day systolic BP ratio remained independently associated with LVMI (beta coefficient 147.62, P=0.004). Of 12 patients who had a non-dipper profile at baseline, 11 (92%) demonstrated the same profile after 6 months and 1 year of follow-up.
  
  
  CONCLUSIONS
  Many hemodialysis patients demonstrate a non-dipper profile; the degree of decline in nocturnal BP is independently associated with LVMI even after adjustment for mean BP. Patients who are identified as non-dippers consistently reproduce the same profile over time.
authors.affiliation: Division of Nephrology and Hypertension, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH 44106, USA. Mahboob.Rahman@uhhs.com
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.forename: Valerie
authors.initials: V
authors.lastname: Griffin
authors.forename: Robert
authors.initials: R
authors.lastname: Heyka
authors.forename: Brian
authors.initials: B
authors.lastname: Hoit
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D015203:Reproducibility of Results