Tags

Type your tag names separated by a space and hit enter

Ambulatory Pulse Wave Velocity Is a Stronger Predictor of Cardiovascular Events and All-Cause Mortality Than Office and Ambulatory Blood Pressure in Hemodialysis Patients.
Hypertension. 2017 07; 70(1):148-157.H

Abstract

Arterial stiffness and augmentation of aortic blood pressure (BP) measured in office are known cardiovascular risk factors in hemodialysis patients. This study examines the prognostic significance of ambulatory brachial BP, central BP, pulse wave velocity (PWV), and heart rate-adjusted augmentation index [AIx(75)] in this population. A total of 170 hemodialysis patients underwent 48-hour ambulatory monitoring with Mobil-O-Graph-NG during a standard interdialytic interval and followed-up for 28.1±11.2 months. The primary end point was a combination of all-cause death, nonfatal myocardial infarction, and nonfatal stroke. Secondary end points included: (1) all-cause mortality; (2) cardiovascular mortality; and (3) a combination of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, resuscitation after cardiac arrest, coronary revascularization, or hospitalization for heart failure. During follow-up, 37(21.8%) patients died and 46(27.1%) had cardiovascular events. Cumulative freedom from primary end point was similar for quartiles of predialysis-systolic BP (SBP), 48-hour peripheral-SBP, and central-SBP, but was progressively longer for increasing quartiles for 48-hour peripheral-diastolic BP and central-diastolic BP and shorter for increasing quartiles of 48-hour central pulse pressure (83.7%, 71.4%, 69.0%, 62.8% [log-rank P=0.024]), PWV (93.0%, 81.0%, 57.1%, 55.8% [log-rank P<0.001]), and AIx(75) (88.4%, 66.7%, 69.0%, 62.8% [log-rank P=0.014]). The hazard ratios for all-cause mortality, cardiovascular mortality, and the combined outcome were similar for quartiles of predialysis-SBP, 48-hour peripheral-SBP, and central-SBP, but were increasing with higher ambulatory PWV and AIx(75). In multivariate analysis, 48-hour PWV was the only vascular parameter independently associated with the primary end point (hazard ratios, 1.579; 95% confidence intervals, 1.187-2.102). Ambulatory PWV, AIx(75), and central pulse pressure are associated with increased risk of cardiovascular events and mortality, whereas office and ambulatory SBP are not. These findings further support that arterial stiffness is the prominent cardiovascular risk factor in hemodialysis.

Authors+Show Affiliations

From the Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece (P.A.S., C.L., G.T., A.P., G.E.); Therapeutiki Hemodialysis Unit, Thessaloniki, Greece (A.K.); Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece (G.K., C.S.); Pieria Hemodialysis Unit, Katerini, Greece (V.R.); Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece (V.L.); Manhès Hospital and FCRIN INI-CRCTC, Fleury Mérogis, France (G.L.); and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.). psarafidis11@yahoo.gr.From the Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece (P.A.S., C.L., G.T., A.P., G.E.); Therapeutiki Hemodialysis Unit, Thessaloniki, Greece (A.K.); Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece (G.K., C.S.); Pieria Hemodialysis Unit, Katerini, Greece (V.R.); Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece (V.L.); Manhès Hospital and FCRIN INI-CRCTC, Fleury Mérogis, France (G.L.); and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.).From the Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece (P.A.S., C.L., G.T., A.P., G.E.); Therapeutiki Hemodialysis Unit, Thessaloniki, Greece (A.K.); Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece (G.K., C.S.); Pieria Hemodialysis Unit, Katerini, Greece (V.R.); Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece (V.L.); Manhès Hospital and FCRIN INI-CRCTC, Fleury Mérogis, France (G.L.); and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.).From the Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece (P.A.S., C.L., G.T., A.P., G.E.); Therapeutiki Hemodialysis Unit, Thessaloniki, Greece (A.K.); Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece (G.K., C.S.); Pieria Hemodialysis Unit, Katerini, Greece (V.R.); Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece (V.L.); Manhès Hospital and FCRIN INI-CRCTC, Fleury Mérogis, France (G.L.); and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.).From the Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece (P.A.S., C.L., G.T., A.P., G.E.); Therapeutiki Hemodialysis Unit, Thessaloniki, Greece (A.K.); Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece (G.K., C.S.); Pieria Hemodialysis Unit, Katerini, Greece (V.R.); Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece (V.L.); Manhès Hospital and FCRIN INI-CRCTC, Fleury Mérogis, France (G.L.); and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.).From the Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece (P.A.S., C.L., G.T., A.P., G.E.); Therapeutiki Hemodialysis Unit, Thessaloniki, Greece (A.K.); Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece (G.K., C.S.); Pieria Hemodialysis Unit, Katerini, Greece (V.R.); Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece (V.L.); Manhès Hospital and FCRIN INI-CRCTC, Fleury Mérogis, France (G.L.); and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.).From the Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece (P.A.S., C.L., G.T., A.P., G.E.); Therapeutiki Hemodialysis Unit, Thessaloniki, Greece (A.K.); Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece (G.K., C.S.); Pieria Hemodialysis Unit, Katerini, Greece (V.R.); Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece (V.L.); Manhès Hospital and FCRIN INI-CRCTC, Fleury Mérogis, France (G.L.); and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.).From the Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece (P.A.S., C.L., G.T., A.P., G.E.); Therapeutiki Hemodialysis Unit, Thessaloniki, Greece (A.K.); Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece (G.K., C.S.); Pieria Hemodialysis Unit, Katerini, Greece (V.R.); Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece (V.L.); Manhès Hospital and FCRIN INI-CRCTC, Fleury Mérogis, France (G.L.); and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.).From the Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece (P.A.S., C.L., G.T., A.P., G.E.); Therapeutiki Hemodialysis Unit, Thessaloniki, Greece (A.K.); Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece (G.K., C.S.); Pieria Hemodialysis Unit, Katerini, Greece (V.R.); Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece (V.L.); Manhès Hospital and FCRIN INI-CRCTC, Fleury Mérogis, France (G.L.); and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.).From the Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece (P.A.S., C.L., G.T., A.P., G.E.); Therapeutiki Hemodialysis Unit, Thessaloniki, Greece (A.K.); Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece (G.K., C.S.); Pieria Hemodialysis Unit, Katerini, Greece (V.R.); Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece (V.L.); Manhès Hospital and FCRIN INI-CRCTC, Fleury Mérogis, France (G.L.); and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.).From the Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece (P.A.S., C.L., G.T., A.P., G.E.); Therapeutiki Hemodialysis Unit, Thessaloniki, Greece (A.K.); Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece (G.K., C.S.); Pieria Hemodialysis Unit, Katerini, Greece (V.R.); Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece (V.L.); Manhès Hospital and FCRIN INI-CRCTC, Fleury Mérogis, France (G.L.); and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.).From the Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece (P.A.S., C.L., G.T., A.P., G.E.); Therapeutiki Hemodialysis Unit, Thessaloniki, Greece (A.K.); Hemodialysis Unit, Achillopouleion General Hospital, Volos, Greece (G.K., C.S.); Pieria Hemodialysis Unit, Katerini, Greece (V.R.); Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece (V.L.); Manhès Hospital and FCRIN INI-CRCTC, Fleury Mérogis, France (G.L.); and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28483919

Citation

Sarafidis, Pantelis A., et al. "Ambulatory Pulse Wave Velocity Is a Stronger Predictor of Cardiovascular Events and All-Cause Mortality Than Office and Ambulatory Blood Pressure in Hemodialysis Patients." Hypertension (Dallas, Tex. : 1979), vol. 70, no. 1, 2017, pp. 148-157.
Sarafidis PA, Loutradis C, Karpetas A, et al. Ambulatory Pulse Wave Velocity Is a Stronger Predictor of Cardiovascular Events and All-Cause Mortality Than Office and Ambulatory Blood Pressure in Hemodialysis Patients. Hypertension. 2017;70(1):148-157.
Sarafidis, P. A., Loutradis, C., Karpetas, A., Tzanis, G., Piperidou, A., Koutroumpas, G., Raptis, V., Syrgkanis, C., Liakopoulos, V., Efstratiadis, G., London, G., & Zoccali, C. (2017). Ambulatory Pulse Wave Velocity Is a Stronger Predictor of Cardiovascular Events and All-Cause Mortality Than Office and Ambulatory Blood Pressure in Hemodialysis Patients. Hypertension (Dallas, Tex. : 1979), 70(1), 148-157. https://doi.org/10.1161/HYPERTENSIONAHA.117.09023
Sarafidis PA, et al. Ambulatory Pulse Wave Velocity Is a Stronger Predictor of Cardiovascular Events and All-Cause Mortality Than Office and Ambulatory Blood Pressure in Hemodialysis Patients. Hypertension. 2017;70(1):148-157. PubMed PMID: 28483919.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ambulatory Pulse Wave Velocity Is a Stronger Predictor of Cardiovascular Events and All-Cause Mortality Than Office and Ambulatory Blood Pressure in Hemodialysis Patients. AU - Sarafidis,Pantelis A, AU - Loutradis,Charalampos, AU - Karpetas,Antonios, AU - Tzanis,Georgios, AU - Piperidou,Alexia, AU - Koutroumpas,Georgios, AU - Raptis,Vasilios, AU - Syrgkanis,Christos, AU - Liakopoulos,Vasilios, AU - Efstratiadis,Georgios, AU - London,Gérard, AU - Zoccali,Carmine, Y1 - 2017/05/08/ PY - 2017/01/04/received PY - 2017/01/18/revised PY - 2017/03/04/accepted PY - 2017/5/10/pubmed PY - 2017/8/25/medline PY - 2017/5/10/entrez KW - ambulatory KW - arterial stiffness KW - augmentation index KW - cardiovascular events KW - hemodialysis KW - mortality KW - pulse wave velocity SP - 148 EP - 157 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 70 IS - 1 N2 - Arterial stiffness and augmentation of aortic blood pressure (BP) measured in office are known cardiovascular risk factors in hemodialysis patients. This study examines the prognostic significance of ambulatory brachial BP, central BP, pulse wave velocity (PWV), and heart rate-adjusted augmentation index [AIx(75)] in this population. A total of 170 hemodialysis patients underwent 48-hour ambulatory monitoring with Mobil-O-Graph-NG during a standard interdialytic interval and followed-up for 28.1±11.2 months. The primary end point was a combination of all-cause death, nonfatal myocardial infarction, and nonfatal stroke. Secondary end points included: (1) all-cause mortality; (2) cardiovascular mortality; and (3) a combination of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, resuscitation after cardiac arrest, coronary revascularization, or hospitalization for heart failure. During follow-up, 37(21.8%) patients died and 46(27.1%) had cardiovascular events. Cumulative freedom from primary end point was similar for quartiles of predialysis-systolic BP (SBP), 48-hour peripheral-SBP, and central-SBP, but was progressively longer for increasing quartiles for 48-hour peripheral-diastolic BP and central-diastolic BP and shorter for increasing quartiles of 48-hour central pulse pressure (83.7%, 71.4%, 69.0%, 62.8% [log-rank P=0.024]), PWV (93.0%, 81.0%, 57.1%, 55.8% [log-rank P<0.001]), and AIx(75) (88.4%, 66.7%, 69.0%, 62.8% [log-rank P=0.014]). The hazard ratios for all-cause mortality, cardiovascular mortality, and the combined outcome were similar for quartiles of predialysis-SBP, 48-hour peripheral-SBP, and central-SBP, but were increasing with higher ambulatory PWV and AIx(75). In multivariate analysis, 48-hour PWV was the only vascular parameter independently associated with the primary end point (hazard ratios, 1.579; 95% confidence intervals, 1.187-2.102). Ambulatory PWV, AIx(75), and central pulse pressure are associated with increased risk of cardiovascular events and mortality, whereas office and ambulatory SBP are not. These findings further support that arterial stiffness is the prominent cardiovascular risk factor in hemodialysis. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/28483919/Ambulatory_Pulse_Wave_Velocity_Is_a_Stronger_Predictor_of_Cardiovascular_Events_and_All_Cause_Mortality_Than_Office_and_Ambulatory_Blood_Pressure_in_Hemodialysis_Patients_ L2 - https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.117.09023?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -