Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Fourth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Eur J Clin Invest. 2022 Dec;52(12):e13861. doi: 10.1111/eci.13861. Epub 2022 Aug 26.
Increased arterial stiffness is suggested to be involved in the pathogenesis of intradialytic-hypertension (IDH). Ambulatory pulse-wave-velocity (PWV) is an independent predictor for all-cause-mortality in haemodialysis and its prognostic power is better than office PWV. This is the first study examining ambulatory central blood pressure (BP) and arterial stiffness parameters in patients with and without IDH.
This study examined 45 patients with IDH (SBP rise ≥10 mmHg from pre- to post-dialysis and post-dialysis SBP ≥150 mmHg) in comparison with 197 patients without IDH. All participants underwent 48-h ABPM with Mobil-O-Graph-NG; parameters of central haemodynamics, wave reflection and PWV were estimated.
Age, dialysis vintage and interdialytic weight gain did not differ between-groups. IDH patients had higher 48-h cSBP (131.7 ± 16.2 vs. 119.2 ± 15.2 mmHg, p < 0.001), 48-h cDBP (86.7 ± 12.7 vs. 79.6 ± 11.5 mmHg, p < 0.001) and 48-h cPP (45.5 ± 10.4 vs. 39.8 ± 10.0 mmHg, p = 0.001) compared to patients without IDH. Similarly, during day- and nighttime periods, cSBP/cDBP and cPP levels were higher in IDH-patients compared to non-IDH. Forty-eight-hour augmentation pressure and index, but not AIx(75) were higher in IDH patients; 48-h PWV (10.0 ± 2.0 vs. 9.2 ± 2.1 m/s, p = 0.017) was significantly higher in patients with IDH. The two study groups displayed different trajectories in central BP and PWV over the course of the recording; IDH patients had steadily high values of the above variables during the 2 days of the interdialytic-interval, whereas non-IDH patients showed a gradual elevation, with significant increases from the 1st to 2nd 24 h.
IDH patients have significantly higher levels of ambulatory central BP and arterial stiffness parameters and a different course over the 48-h period compared with non-IDH patients. Increased arterial stiffness could be a prominent factor associated with the high burden of cardiovascular disease in this population.
动脉僵硬度增加被认为与透析中高血压（IDH）的发病机制有关。动态脉搏波速度（PWV）是血液透析患者全因死亡率的独立预测因素，其预后能力优于诊室 PWV。这是第一项研究，检查了有和没有 IDH 的患者的动态中心血压（BP）和动脉僵硬度参数。
本研究共纳入 45 名 IDH 患者（透析前至透析后收缩压升高≥10mmHg，透析后收缩压≥150mmHg），并与 197 名无 IDH 的患者进行比较。所有参与者均接受 Mobil-O-Graph-NG 进行 48 小时 ABPM；估计中心血流动力学、波反射和 PWV 参数。
两组之间的年龄、透析龄和透析间期体重增加无差异。IDH 患者的 48 小时 cSBP（131.7±16.2 与 119.2±15.2mmHg，p<0.001）、48 小时 cDBP（86.7±12.7 与 79.6±11.5mmHg，p<0.001）和 48 小时 cPP（45.5±10.4 与 39.8±10.0mmHg，p=0.001）均高于无 IDH 患者。同样，在白天和夜间期间，IDH 患者的 cSBP/cDBP 和 cPP 水平均高于非 IDH 患者。IDH 患者的 48 小时增强压和指数较高，但 AIx（75）较高；IDH 患者的 48 小时 PWV（10.0±2.0 与 9.2±2.1m/s，p=0.017）显著升高。两组患者在记录过程中的中心 BP 和 PWV 呈现出不同的轨迹；IDH 患者在透析间期的两天内始终保持较高的上述变量值，而非 IDH 患者则逐渐升高，从第 1 天到第 2 天 24 小时有显著增加。
与非 IDH 患者相比，IDH 患者的动态中心 BP 和动脉僵硬度参数水平明显更高，并且在 48 小时内的变化过程也不同。动脉僵硬度增加可能是该人群心血管疾病负担增加的一个重要因素。
