Abstract: FR-PO362
Prevalence and Risk Factors of Altered Control of BP during the Night in a Large Hemodialysis Population Evaluated by 48-Hour Ambulatory BP Monitoring
Session Information
- Hypertension, CVD, and the Kidneys: Epidemiology
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Mallamaci, Francesca, GOM Bianchi Melacrino Morelli, Nephrology Unit, Reggio Calabria, Italy
- Torino, Claudia, IFC-CNR, Reggio Calabria, Italy
- Sarafidis, Pantelis, Aristotle University, Thessaloniki, Thessaloniki, Greece
- Ekart, Robert, University Clinical Centre Maribor, Maribor, Slovenia
- Balafa, Olga, University Hospital of Ioannina, Ioannina, Greece
- Del Giudice, Antonio M., Nephrology Unit “Casa Sollievo della Sofferenza” San Giovanni Rotondo, San Giovanni Rotondo, Italy
- Aucella, Filippo, Nephrology Unit “Casa Sollievo della Sofferenza” San Giovanni Rotondo, San Giovanni Rotondo, Italy
- Morosetti, Massimo, Nephrology Unit, ASL Roma 3, Roma, Italy
- Tripepi, Rocco, IFC-CNR, Reggio Calabria, Italy
- Marino, Carmela, IFC-CNR, Reggio Calabria, Italy
- Tripepi, Giovanni, IFC-CNR, Reggio Calabria, Italy
- Zoccali, Carmine, Renal Research Institute, New York, New York, United States
Background
Altered BP control during the night is recognized as a powerful risk factor for death and CV events in the hemodialysis (HD) population. However, these alterations have been described in relatively small studies and the epidemiology and risk factors for subtypes non-dipping and nocturnal hypertension are still poorly characterized in the current literature. We investigated the problem in the large EURECA-m Registry, the sole adopting 48h ABPM recording in the HD population.
Methods
We included in this analysis 534 HD patients, from 7 centers, led by members of the EURECA-m working group, in 3 European countries. 48h ABPM was measured by using well validated instruments (AAMI/ESH/ISO). As recommended by the ESH guidelines, recordings were made at 15- minute intervals during the day and 30 minutes during the night. Hypertension was defined as 48h blood pressure (BP)>130/80, nocturnal hypertension as a nighttime BP>120/70 mmHg, non-dipping as a night/day systolic BP fall <10% and reverse dipping as a night/day ratio>1.
Results
Among 534 HD patients, 317 were hypertensive and. 217 normotensive. 274 patients were non-dippers (51%), 32% were reverse dippers, and 381 (71%) had nocturnal hypertension. Of note, forty-one per cent of non-dippers, 37% of reverse dippers and 19% of patients with nocturnal hypertension were normotensives. As expected, the majority of reverse dippers (87%) had frank nocturnal hypertension. In a combined analysis of non-dippers and reverse dippers, as compared to dippers, these patients more frequently exhibited atrial fibrillation and had lower Heart Rate both pre-dialysis (72± 11 vs 77±13 bpm, P=0.004) and post-dialysis (74± 13 vs 78±14 bpm, P=0.03) and lower serum albumin (3.9±0.4 vs 4.0±0.3 g/dL, P=0.02) but did not differ for age and gender.
Conclusion
In a large cohort of HD patients investigated by the state-of-the-art technique, 48hABPM alterations in the nocturnal BP profile were almost universal, and nocturnal hypertension was the more prevalent alteration, followed by non-dipping and reverse dipping. These alterations were independent of age and gender. Long-term, granular follow-up analyses are warranted to identify the prognostic value of these alterations.