title: Relationship between different blood pressure measurements and left ventricular mass by cardiac magnetic resonance imaging in end-stage renal disease.
abstract: Hypertension is prevalent in patients with end-stage renal disease and is strongly associated with left ventricular hypertrophy (LVH), an independent predictor of cardiovascular mortality. Blood pressure (BP) monitoring in hemodialysis patients may be unreliable because of its lability and variability. We compared different methods of BP measurement and their relationship with LVH on cardiac magnetic resonance imaging. Sixty patients undergoing chronic hemodialysis at a single dialysis center had BP recorded at each dialysis session over 12 weeks: pre-dialysis, initial dialysis, nadir during dialysis, and post-dialysis. Forty-five of these patients also underwent 44-hour inter-dialytic ambulatory BP monitoring. Left ventricular mass index (LVMI) was measured using cardiac magnetic resonance imaging and the presence of LVH was ascertained. Receiver operator characteristic curves were generated for each BP measurement for predicting LVH. The mean LVMI was 68 g/m(2) (SD = 15 g/m(2)); 13/60 patients (22%) had LVH. Mean arterial pressure measured shortly after initiation of dialysis session was most strongly correlated with LVMI (Pearson correlation coefficient r = 0.59, P < .0001). LVH was best predicted by post-dialysis systolic BP (area under the curve, 0.83; 95% confidence interval, 0.72-0.94) and initial dialysis systolic BP (area under the curve, 0.81; 95% confidence interval, 0.70-0.92). Forty-four-hour ambulatory BP and BP variability did not significantly predict LVH. Initial dialysis mean arterial pressure and systolic BP and post-dialysis systolic BP are the strongest predictors of LVH, and may represent the potentially best treatment targets in hemodialysis patients to prevent end-organ damage. Further studies are needed to confirm whether treatment targeting these BP measurements can optimize cardiovascular outcomes.
authors.affiliation: University of Toronto, Toronto, ON, Canada; Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Asad
authors.initials: A
authors.lastname: Merchant
authors.affiliation: University of Toronto, Toronto, ON, Canada; Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. Electronic address: waldr@smh.ca.
authors.forename: Ron
authors.initials: R
authors.lastname: Wald
authors.affiliation: Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Marc B
authors.initials: MB
authors.lastname: Goldstein
authors.affiliation: Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: Yuen
authors.affiliation: University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Anish
authors.initials: A
authors.lastname: Kirpalani
authors.affiliation: Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Niki
authors.initials: N
authors.lastname: Dacouris
authors.affiliation: University of Toronto, Toronto, ON, Canada; Department of Obstetrics and Gynecology, and Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Joel G
authors.initials: JG
authors.lastname: Ray
authors.affiliation: Division of Nephrology, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Mercedeh
authors.initials: M
authors.lastname: Kiaii
authors.affiliation: Department of Radiology and Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Vamshi
authors.initials: V
authors.lastname: Kotha
authors.affiliation: University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Djeven
authors.initials: D
authors.lastname: Deva
authors.affiliation: University of Toronto, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada. Electronic address: yana@smh.ca.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
mesh_terms: D000328:Adult; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods*; D018660:Blood Pressure Monitoring, Ambulatory; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis
keywords: Hemodialysis; hypertension; left ventricular hypertrophy; mean arterial pressure