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Visit-to-visit systolic blood pressure variability and outcomes in hemodialysis

Journal of Human Hypertension volume 28, pages 18–24 (2014)Cite this article

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Abstract

Visit-to-visit blood pressure variability (VTV-BPV) is an independent risk factor for cardiovascular events and death in the general population. We sought to determine the association of VTV-BPV with outcomes in patients on hemodialysis, using data from a National Institutes of Health-sponsored randomized trial (the HEMO study). We used the coefficient of variation (CV) and the average real variability in systolic blood pressure (SBP) as metrics of VTV-BPV. In all, 1844 out of 1846 randomized subjects had at least three visits with SBP measurements and were included in the analysis. Median follow-up was 2.5 years (interquartile range 1.3–4.3 years), during which time there were 869 deaths from any cause and 408 (adjudicated) cardiovascular deaths. The mean pre-dialysis SBP CV was 9.9±4.6%. In unadjusted models, we found a 31% higher risk of death from any cause per 10% increase in VTV-BPV. This association was attenuated after multivariable adjustment but remained statistically significant. Similarly, we found a 28% higher risk of cardiovascular death per 10% increase in VTV-BPV, which was attenuated and no longer statistically significant in fully adjusted models. The associations among VTV-BPV, death and cardiovascular death were modified by baseline SBP. In a diverse, well-dialyzed cohort of patients on maintenance hemodialysis, VTV-BPV, assessed using metrics of variability in pre-dialysis SBP, was associated with a higher risk of all-cause mortality and a trend toward higher risk of cardiovascular mortality, particularly in patients with a lower baseline SBP.

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Acknowledgements

Dr Chang is funded by an American Heart Association National Scientist Development Grant (SDG11670032). Dr Chertow is supported by NIDDK K24 085446. The HEMO study was conducted by the HEMO study Investigators and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). This manuscript does not necessarily reflect the opinions or views of HEMO study or the NIDDK.

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA

    T I Chang & G M Chertow

  2. Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    J E Flythe & S M Brunelli

  3. Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Birmingham, AL, USA

    P Muntner

  4. Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA,

    T Greene & A K Cheung

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  1. T I Chang
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Correspondence to G M Chertow.

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Chang, T., Flythe, J., Brunelli, S. et al. Visit-to-visit systolic blood pressure variability and outcomes in hemodialysis. J Hum Hypertens 28, 18–24 (2014). https://doi.org/10.1038/jhh.2013.49

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