CIRCADIAN VARIATION OF AORTIC AND BRACHIAL BLOOD PRESSURE IN PERITONEAL DIALYSIS PATIENTS. (June 2018)

• Record Type: Journal Article
• Authors: Vaios, V.; Georgianos, P.; Vareta, G.; Papagianni, A.; Zebekakis, P.; Liakopoulos, V.
• Is Part Of: Journal of hypertension. Volume 36(2018)Supplement 1
• Publication Date: 2018-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000539787.18611.c4
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Hypertension among patients on peritoneal dialysis (PD) is common, difficult to diagnose and often poorly controlled. Diagnosis and the overall management of hypertension among these patients are routinely based on brachial blood pressure (BP) recordings taken either in the office or by the patients themselves at home. Studies in the general hypertensive population have shown that aortic pressures are lower, display different circadian variation and are prognostically more informative than brachial BP recordings. However, the circadian patterns and rhythms of aortic pressures in PD patients are unknown. The aim of this study is to evaluate the circadian variation of aortic and brachial BP among patients receiving PD. Design and method: A cross-sectional analysis of 22 consecutive patients on long-term PD (mean age: 62.7 ± 15.5 years; Gender: 16 male and 6 female) who underwent 24-hour brachial and aortic BP monitoring with the Mobil-O-Graph device (IEM, Germany). Herein, we provide a comparative analysis of central aortic versus brachial BP during the 24-hour, day-time and night-time periods. Results: Aortic systolic BP (SBP) was significantly lower than brachial SBP during the 24-hour, day-time and night-time periods (24-hour period: 118.0 ± 14.1 vs 128.4 ± 14.6 mmHg, P < 0.001; day-time: 118.9 ± 13.5 vs 129.5 ± 13.8 mmHg, P < 0.001; night-time: 116.5 ± 17.3 vs 126.4 ± 18.2 mmHg, P < 0.001). Aortic pulse pressure (PP) was also significantly lower than brachial PP during the 24-hour, day-time and night-time periods (24-hour period: 36.3 ± 8.4 vs 45.2 ± 9.6 mmHg, P < 0.001; day-time: 35.3 ± 8.7 vs 46.3 ± 9.5 mmHg, P < 0.001; night-time: 36.9 ± 9.7 vs 44.8 ± 12.0 mmHg, P < 0.001). Aortic-to-brachial PP amplification was higher during day-time than during night-time (10.9 ± 1.7 vs 7.9 ± 1.9 mmHg, P < 0.05). A similar pattern was evident when the analysis was performed separately for patients receiving continuous ambulatory PD and automated PD. Conclusions: Ambulatory aortic SBP and PP is by ∼10 mmHg lower than ambulatory brachial SBP and PP. Additional studies are warranted to elucidate whether ambulatory aortic pressures are superior to brachial BP in detecting the presence of target-organ damage and prognosticating the mortality risk among patients on PD.