Aortic Stiffness, Ambulatory Blood Pressure, and Predictors of Response to Antihypertensive Therapy in Hemodialysis

Panagiotis I. Georgianos, Rajiv Agarwal

Research output: Contribution to journalArticle

4 Citations (Scopus)

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. Study Design Post hoc analysis of the Hypertension in Hemodialysis Patients Treated With Atenolol or Lisinopril (HDPAL) trial. Settings & Participants 179 hypertensive hemodialysis patients with echocardiographic left ventricular hypertrophy. Predictor Baseline aortic pulse wave velocity (PWV). Outcome Baseline and treatment-induced change in 44-hour ambulatory BP at 3, 6, and 12 months. Measurements 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 mm Hg 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). Limitations 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.

Original languageEnglish
Pages (from-to)305-312
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume66
Issue number2
DOIs
StatePublished - Aug 1 2015

Fingerprint

Vascular Stiffness
Antihypertensive Agents
Renal Dialysis
Pulse Wave Analysis
Blood Pressure
Therapeutics
Hypertension
Dialysis
Cupressus
Lisinopril
Ambulatory Blood Pressure Monitoring
Atenolol
Left Ventricular Hypertrophy

Keywords

  • ambulatory blood pressure
  • aortic stiffness
  • arteriosclerosis
  • BP control
  • echocardiographic left ventricular hypertrophy
  • hemodialysis (HD)
  • Hypertension in Hemodialysis Patients Treated with Atenolol or Lisinopril (HDPAL) trial
  • Index Words Antihypertensive treatment
  • pulse wave velocity (PWV)
  • renal replacement therapy (RRT)

ASJC Scopus subject areas

  • Nephrology

Cite this

Aortic Stiffness, Ambulatory Blood Pressure, and Predictors of Response to Antihypertensive Therapy in Hemodialysis. / Georgianos, Panagiotis I.; Agarwal, Rajiv.

In: American Journal of Kidney Diseases, Vol. 66, No. 2, 01.08.2015, p. 305-312.

Research output: Contribution to journalArticle

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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. Study Design Post hoc analysis of the Hypertension in Hemodialysis Patients Treated With Atenolol or Lisinopril (HDPAL) trial. Settings & Participants 179 hypertensive hemodialysis patients with echocardiographic left ventricular hypertrophy. Predictor Baseline aortic pulse wave velocity (PWV). Outcome Baseline and treatment-induced change in 44-hour ambulatory BP at 3, 6, and 12 months. Measurements 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 mm Hg 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). Limitations 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.",
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N2 - 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. Study Design Post hoc analysis of the Hypertension in Hemodialysis Patients Treated With Atenolol or Lisinopril (HDPAL) trial. Settings & Participants 179 hypertensive hemodialysis patients with echocardiographic left ventricular hypertrophy. Predictor Baseline aortic pulse wave velocity (PWV). Outcome Baseline and treatment-induced change in 44-hour ambulatory BP at 3, 6, and 12 months. Measurements 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 mm Hg 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). Limitations 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.

AB - 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. Study Design Post hoc analysis of the Hypertension in Hemodialysis Patients Treated With Atenolol or Lisinopril (HDPAL) trial. Settings & Participants 179 hypertensive hemodialysis patients with echocardiographic left ventricular hypertrophy. Predictor Baseline aortic pulse wave velocity (PWV). Outcome Baseline and treatment-induced change in 44-hour ambulatory BP at 3, 6, and 12 months. Measurements 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 mm Hg 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). Limitations 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.

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KW - echocardiographic left ventricular hypertrophy

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KW - Hypertension in Hemodialysis Patients Treated with Atenolol or Lisinopril (HDPAL) trial

KW - Index Words Antihypertensive treatment

KW - pulse wave velocity (PWV)

KW - renal replacement therapy (RRT)

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