title: Aortic Stiffness, Ambulatory Blood Pressure, and Predictors of Response to Antihypertensive Therapy in Hemodialysis.
abstract: BACKGROUND
  Arterial stiffness is associated with elevated blood pressure (BP), but it is unclear whether it also makes hypertension more resistant to treatment. Among hypertensive dialysis patients, this study investigated whether aortic stiffness determines ambulatory BP and predicts its improvement with therapy.
  
  
  METHODS
  Post hoc analysis of the Hypertension in Hemodialysis Patients Treated With Atenolol or Lisinopril (HDPAL) trial.
  
  
  METHODS
  179 hypertensive hemodialysis patients with echocardiographic left ventricular hypertrophy.
  
  
  METHODS
  Baseline aortic pulse wave velocity (PWV).
  
  
  RESULTS
  Baseline and treatment-induced change in 44-hour ambulatory BP at 3, 6, and 12 months.
  
  
  METHODS
  Aortic PWV was assessed with an echocardiographic-Doppler technique (ACUSON Cypress, Siemens Medical), and 44-hour interdialytic ambulatory BP monitoring was performed with a Spacelabs 90207 monitor.
  
  
  RESULTS
  Mean baseline aortic PWV was 7.6±2.7 (SD) m/s. Overall treatment-induced changes in ambulatory systolic BP (SBP) were -15.6±20.4, -18.9±22.5, and -20.0±19.7 mmHg at 3, 6, and 12 months. Changes in SBP were no different among tertiles of baseline PWV. Aortic PWV was associated directly with baseline ambulatory SBP and pulse pressure (PP) and inversely with diastolic BP (DBP). After adjustment for several cardiovascular risk factors, each 1-m/s higher PWV was associated with 1.34-mm Hg higher baseline SBP (β=1.34±0.46; P=0.004) and 1.02-mm Hg higher PP (β=1.02±0.33; P=0.002), whereas the association with DBP was no longer significant. Baseline PWV did not predict treatment-induced changes in SBP (Wald test, P=0.3) and DBP (Wald test, P=0.7), but was a predictor of an overall improvement in PP during follow-up (Wald test, P=0.03).
  
  
  CONCLUSIONS
  Observational design; predominantly black patients were studied.
  
  
  CONCLUSIONS
  Because aortic PWV is not a predictor of treatment-induced change in ambulatory BP among hypertensive dialysis patients, it indicates that among these patients, hypertension can be controlled successfully regardless of aortic stiffness.
authors.affiliation: Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN.
authors.forename: Panagiotis I
authors.initials: PI
authors.lastname: Georgianos
authors.affiliation: Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN. Electronic address: ragarwal@iu.edu.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology; D001262:Atenolol / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory; D057239:Early Termination of Clinical Trials; D015150:Echocardiography, Doppler; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D017706:Lisinopril / Q000627:therapeutic use; D063177:Pulse Wave Analysis; D006435:Renal Dialysis; D016896:Treatment Outcome; D059289:Vascular Stiffness / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents; D001262:Atenolol; D017706:Lisinopril
keywords: Antihypertensive treatment; BP control; Hypertension in Hemodialysis Patients Treated with Atenolol or Lisinopril (HDPAL) trial; ambulatory blood pressure; aortic stiffness; arteriosclerosis; echocardiographic left ventricular hypertrophy; hemodialysis (HD); pulse wave velocity (PWV); renal replacement therapy (RRT)