Relationship between changes in blood pressure and left ventricular mass over 1 year in end-stage renal disease.
The optimal timing of blood pressure (BP) measurement is not firmly established for patients undergoing hemodialysis. We sought to assess which BP measurement change best correlates with changes in left ventricular mass index (LVMI) over 1 year in patients with end-stage renal disease.



Fifty-seven patients were included in a prospective cohort study comparing the cardiovascular impact of conversion to in-center nocturnal hemodialysis versus continuing conventional hemodialysis. BP measurements were recorded at different time points (predialysis, after initiation of dialysis, at the intradialytic nadir, and postdialysis) during dialysis sessions over 12 weeks at baseline and after 1-year follow-up. LVMI was independently measured by a single blinded reader using cardiac magnetic resonance imaging at baseline and 1 year.



Overall, the mean LVMI was 69.9 g/m (standard deviation 15.9) at baseline and 69.6 g/m (standard deviation 16.0) at 1 year. The change in initiation mean arterial pressure (MAP) most strongly correlated with the change in LVMI (Pearson correlation coefficient r = 0.71, P < 0.001). The relationship was similar in both dialysis groups and in multivariable analysis. In pairwise comparisons, initiation MAP was more strongly correlated with the change in LVMI than nadir and postdialysis measurements (all P < 0.05). However, the correlation was not stronger than predialysis SBP (P = 0.33).



The change in initiation MAP correlated best with the change in LVMI over 1 year in patients undergoing hemodialysis. Further studies are needed to determine whether it represents a potentially useful treatment target to prevent adverse ventricular remodeling, thereby improving cardiovascular outcome.ClinicalTrials.gov Identifier: NCT00718848.
aTerrence Donnelly Heart Centre, St Michael's Hospital bUniversity of Toronto cDivision of Nephrology, St Michael's Hospital and Li Ka Shing Knowledge Institute of St Michael's Hospital dDepartment of Medical Imaging, St Michael's Hospital, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario eDepartment of Radiology and Medicine fDivision of Nephrology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Bradley
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Sarak
Ron
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Wald
Marc B
MB
Goldstein
Djeven P
DP
Deva
Jonathon
J
Leipsic
Mercedeh
M
Kiaii
General
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Leung
Joseph J
JJ
Barfett
Jeffrey
J
Perl
Darren A
DA
Yuen
Kim A
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Connelly
Andrew T
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Yan
D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D015331:Cohort Studies; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020257:Ventricular Remodeling