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Hydration status and blood pressure variability in primary hypertensive patients.
Nefrologia. 2020 Jun 11 [Online ahead of print]N

Abstract

BACKGROUND

Increased blood pressure variability (BPV) is associated with higher cardiovascular risk. The association between BPV and fluid status in hypertensive patients has not been investigated so far. The aim of the present study was to determine the contribution of fluid balance to BPV and impact on endothelial and cardiac functions among primary hypertensive patients.

METHODS

This is a prospective interventional study conducted in primary hypertensive patients with one-year follow-up. Volume status measurements by a body composition monitor, ambulatory blood pressure (BP) monitoring, echocardiographic and carotid intima-media thickness (CIMT) measurements were performed at enrollment and at twelfth. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. Patients in other group were positively hydrated (hypervolemic) at enrollment, antihypertensive drugs other than diuretics (vasodilator agents) were added or intensified according to the BP monitoring. Average real variability (ARV) index was used for establishing the prognostic significance of BPV.

RESULTS

The study population consisted of 50 patients with a mean age of 54.5±8.8 years. At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower BP, CIMT, left ventricle mass index (LVMI) and systolic and diastolic ARV. More weight gain and higher systolic BP were major risk factors of high systolic ARV. Patients who have improvement in CIMT and LVMI were considered as target organ damage (TOD) recovery present. In negatively hydrated group, TOD significantly reduced during trial. In patients who have TOD recovery, BPV significantly more reduced like systolic and diastolic BP. Significant risk factors associated with the presence of TOD were 24h systolic BP and daytime and night time diastolic ARV and night time diastolic BP.

CONCLUSION

Addition of diuretic to established treatment or intensified diuretic treatment and keeping patients in negative hydration status resulted in reduction in BPV at twelfth month of follow-up. More weight gain and higher systolic BP are major risk factors of high systolic ARV, but not hypervolemia. BPV, especially diastolic ARV, was significantly associated with TOD.

Authors+Show Affiliations

Department of Internal Medicine and Clinical Nutrition, Kayseri City Training and Research Hospital, Kayseri, Turkey. Electronic address: osdizdar@gmail.com.Department of Internal Medicine, Kayseri City Training and Research Hospital, Kayseri, Turkey.Department of Cardiology, Kayseri City Training and Research Hospital, Kayseri, Turkey.Department of Cardiology, Kayseri City Training and Research Hospital, Kayseri, Turkey.Department of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey.Department of Internal Medicine Division of Nephrology, Kayseri City Training and Research Hospital, Kayseri, Turkey.

Pub Type(s)

Journal Article

Language

eng spa

PubMed ID

32536454

Citation

Dizdar, Oguzhan Sıtkı, et al. "Hydration Status and Blood Pressure Variability in Primary Hypertensive Patients." Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia, 2020.
Dizdar OS, Yeşiltepe A, Dondurmaci E, et al. Hydration status and blood pressure variability in primary hypertensive patients. Nefrologia. 2020.
Dizdar, O. S., Yeşiltepe, A., Dondurmaci, E., Ozkan, E., Koç, A., & Gunal, A. I. (2020). Hydration status and blood pressure variability in primary hypertensive patients. Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia. https://doi.org/10.1016/j.nefro.2020.02.002
Dizdar OS, et al. Hydration Status and Blood Pressure Variability in Primary Hypertensive Patients. Nefrologia. 2020 Jun 11; PubMed PMID: 32536454.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hydration status and blood pressure variability in primary hypertensive patients. AU - Dizdar,Oguzhan Sıtkı, AU - Yeşiltepe,Ali, AU - Dondurmaci,Engin, AU - Ozkan,Eyup, AU - Koç,Ali, AU - Gunal,Ali Ihsan, Y1 - 2020/06/11/ PY - 2019/07/02/received PY - 2020/02/04/revised PY - 2020/02/07/accepted PY - 2020/6/16/entrez KW - Blood pressure variability KW - Cardiac functions KW - Endotelio KW - Endothelium KW - Estado hidroelectrolítico KW - Fluid status KW - Funciones cardíacas KW - Hipertensión KW - Hypertension KW - Variabilidad en la presión arterial JF - Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia JO - Nefrologia N2 - BACKGROUND: Increased blood pressure variability (BPV) is associated with higher cardiovascular risk. The association between BPV and fluid status in hypertensive patients has not been investigated so far. The aim of the present study was to determine the contribution of fluid balance to BPV and impact on endothelial and cardiac functions among primary hypertensive patients. METHODS: This is a prospective interventional study conducted in primary hypertensive patients with one-year follow-up. Volume status measurements by a body composition monitor, ambulatory blood pressure (BP) monitoring, echocardiographic and carotid intima-media thickness (CIMT) measurements were performed at enrollment and at twelfth. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. Patients in other group were positively hydrated (hypervolemic) at enrollment, antihypertensive drugs other than diuretics (vasodilator agents) were added or intensified according to the BP monitoring. Average real variability (ARV) index was used for establishing the prognostic significance of BPV. RESULTS: The study population consisted of 50 patients with a mean age of 54.5±8.8 years. At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower BP, CIMT, left ventricle mass index (LVMI) and systolic and diastolic ARV. More weight gain and higher systolic BP were major risk factors of high systolic ARV. Patients who have improvement in CIMT and LVMI were considered as target organ damage (TOD) recovery present. In negatively hydrated group, TOD significantly reduced during trial. In patients who have TOD recovery, BPV significantly more reduced like systolic and diastolic BP. Significant risk factors associated with the presence of TOD were 24h systolic BP and daytime and night time diastolic ARV and night time diastolic BP. CONCLUSION: Addition of diuretic to established treatment or intensified diuretic treatment and keeping patients in negative hydration status resulted in reduction in BPV at twelfth month of follow-up. More weight gain and higher systolic BP are major risk factors of high systolic ARV, but not hypervolemia. BPV, especially diastolic ARV, was significantly associated with TOD. SN - 1989-2284 UR - https://www.unboundmedicine.com/medline/citation/32536454/Hydration_status_and_blood_pressure_variability_in_primary_hypertensive_patients L2 - http://www.revistanefrologia.com/es/linksolver/ft/pii/S0211-6995(20)30035-7 DB - PRIME DP - Unbound Medicine ER -
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