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Cross-sectional association of volume, blood pressures, and aortic stiffness with left ventricular mass in incident hemodialysis patients: the Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study.

Kim ED, Sozio SM, Estrella MM, Jaar BG, Shafi T, Meoni LA, Kao WH, Lima JA, Parekh RS - BMC Nephrol (2015)

Bottom Line: Each systolic, diastolic blood, and pulse pressure measurement was significantly associated with LVMI by linear regression regardless of dialysis unit BP or non-dialysis day BP measurements.Adjusting for cardiovascular confounders, every 10 mmHg increase in systolic or diastolic BP was significantly associated with higher LVMI (SBP β = 7.26, 95 % CI: 4.30, 10.23; DBP β = 10.05, 95 % CI: 5.06, 15.04), and increased pulse pressure was also associated with higher LVMI (β = 0.71, 95 % CI: 0.29, 1.13).Intradialytic weight gain was also associated with higher LVMI but attenuated effects after adjustment (β = 3.25, 95 % CI: 0.67, 5.83).

View Article: PubMed Central - PubMed

Affiliation: Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. estherdw.kim@mail.utoronto.ca.

ABSTRACT

Background: Higher left ventricular mass (LV) strongly predicts cardiovascular mortality in hemodialysis patients. Although several parameters of preload and afterload have been associated with higher LV mass, whether these parameters independently predict LV mass, remains unclear.

Methods: This study examined a cohort of 391 adults with incident hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study. The main exposures were systolic and diastolic blood pressure (BP), pulse pressure, arterial stiffness by pulse wave velocity (PWV), volume status estimated by pulmonary pressures using echocardiogram and intradialytic weight gain. The primary outcome was baseline left ventricular mass index (LVMI).

Results: Each systolic, diastolic blood, and pulse pressure measurement was significantly associated with LVMI by linear regression regardless of dialysis unit BP or non-dialysis day BP measurements. Adjusting for cardiovascular confounders, every 10 mmHg increase in systolic or diastolic BP was significantly associated with higher LVMI (SBP β = 7.26, 95 % CI: 4.30, 10.23; DBP β = 10.05, 95 % CI: 5.06, 15.04), and increased pulse pressure was also associated with higher LVMI (β = 0.71, 95 % CI: 0.29, 1.13). Intradialytic weight gain was also associated with higher LVMI but attenuated effects after adjustment (β = 3.25, 95 % CI: 0.67, 5.83). PWV and pulmonary pressures were not associated with LVMI after multivariable adjustment (β = 0.19, 95 % CI: -1.14, 1.79; and β = 0.10, 95 % CI: -0.51, 0.70, respectively). Simultaneously adjusting for all main exposures demonstrated that higher BP was independently associated with higher LVMI (SBP β = 5.64, 95 % CI: 2.78, 8.49; DBP β = 7.29, 95 % CI: 2.26, 12.31, for every 10 mmHg increase in BP).

Conclusions: Among a younger and incident hemodialysis population, higher systolic, diastolic, or pulse pressure, regardless of timing with dialysis, is most associated with higher LV mass. Future studies should consider the use of various BP measures in examining the impact of BP on LVM and cardiovascular disease. Findings from such studies could suggest that high BP should be more aggressively treated to promote LVH regression in incident hemodialysis patients.

No MeSH data available.


Related in: MedlinePlus

Scatterplots of left ventricular mass index (LVMI) and systolic and diastolic blood pressure at various time points as a three-month average of the predialysis measurement prior to the study visit; b predialysis measurement prior to the study visit; c seated non-dialysis BP measurement and d supine non-dialysis measurement
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Fig1: Scatterplots of left ventricular mass index (LVMI) and systolic and diastolic blood pressure at various time points as a three-month average of the predialysis measurement prior to the study visit; b predialysis measurement prior to the study visit; c seated non-dialysis BP measurement and d supine non-dialysis measurement

Mentions: Figure 1 illustrates side-by-side scatterplots of LVMI, SBP, and DBP by type of BP measurement. In all four measurements of BP, SBP and DBP have graded linear associations with LVMI; however, DBP consistently shows a steeper slope with LVMI than SBP. These patterns are consistent regardless of timing of the BP measurement. Figure 2 illustrates the quartiles of non-dialysis seated BP measurements and trends of LVMI, stratified by ethnicity. The plots demonstrate a significant positive association between quartiles of SBP and DBP, and LVMI among African Americans. Among non-African Americans, only SBP is significantly associated with LVMI. Similar associations are depicted using other BP measurements (Additional file 1: Figure S1–S3).Fig. 1


Cross-sectional association of volume, blood pressures, and aortic stiffness with left ventricular mass in incident hemodialysis patients: the Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study.

Kim ED, Sozio SM, Estrella MM, Jaar BG, Shafi T, Meoni LA, Kao WH, Lima JA, Parekh RS - BMC Nephrol (2015)

Scatterplots of left ventricular mass index (LVMI) and systolic and diastolic blood pressure at various time points as a three-month average of the predialysis measurement prior to the study visit; b predialysis measurement prior to the study visit; c seated non-dialysis BP measurement and d supine non-dialysis measurement
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4528691&req=5

Fig1: Scatterplots of left ventricular mass index (LVMI) and systolic and diastolic blood pressure at various time points as a three-month average of the predialysis measurement prior to the study visit; b predialysis measurement prior to the study visit; c seated non-dialysis BP measurement and d supine non-dialysis measurement
Mentions: Figure 1 illustrates side-by-side scatterplots of LVMI, SBP, and DBP by type of BP measurement. In all four measurements of BP, SBP and DBP have graded linear associations with LVMI; however, DBP consistently shows a steeper slope with LVMI than SBP. These patterns are consistent regardless of timing of the BP measurement. Figure 2 illustrates the quartiles of non-dialysis seated BP measurements and trends of LVMI, stratified by ethnicity. The plots demonstrate a significant positive association between quartiles of SBP and DBP, and LVMI among African Americans. Among non-African Americans, only SBP is significantly associated with LVMI. Similar associations are depicted using other BP measurements (Additional file 1: Figure S1–S3).Fig. 1

Bottom Line: Each systolic, diastolic blood, and pulse pressure measurement was significantly associated with LVMI by linear regression regardless of dialysis unit BP or non-dialysis day BP measurements.Adjusting for cardiovascular confounders, every 10 mmHg increase in systolic or diastolic BP was significantly associated with higher LVMI (SBP β = 7.26, 95 % CI: 4.30, 10.23; DBP β = 10.05, 95 % CI: 5.06, 15.04), and increased pulse pressure was also associated with higher LVMI (β = 0.71, 95 % CI: 0.29, 1.13).Intradialytic weight gain was also associated with higher LVMI but attenuated effects after adjustment (β = 3.25, 95 % CI: 0.67, 5.83).

View Article: PubMed Central - PubMed

Affiliation: Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. estherdw.kim@mail.utoronto.ca.

ABSTRACT

Background: Higher left ventricular mass (LV) strongly predicts cardiovascular mortality in hemodialysis patients. Although several parameters of preload and afterload have been associated with higher LV mass, whether these parameters independently predict LV mass, remains unclear.

Methods: This study examined a cohort of 391 adults with incident hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study. The main exposures were systolic and diastolic blood pressure (BP), pulse pressure, arterial stiffness by pulse wave velocity (PWV), volume status estimated by pulmonary pressures using echocardiogram and intradialytic weight gain. The primary outcome was baseline left ventricular mass index (LVMI).

Results: Each systolic, diastolic blood, and pulse pressure measurement was significantly associated with LVMI by linear regression regardless of dialysis unit BP or non-dialysis day BP measurements. Adjusting for cardiovascular confounders, every 10 mmHg increase in systolic or diastolic BP was significantly associated with higher LVMI (SBP β = 7.26, 95 % CI: 4.30, 10.23; DBP β = 10.05, 95 % CI: 5.06, 15.04), and increased pulse pressure was also associated with higher LVMI (β = 0.71, 95 % CI: 0.29, 1.13). Intradialytic weight gain was also associated with higher LVMI but attenuated effects after adjustment (β = 3.25, 95 % CI: 0.67, 5.83). PWV and pulmonary pressures were not associated with LVMI after multivariable adjustment (β = 0.19, 95 % CI: -1.14, 1.79; and β = 0.10, 95 % CI: -0.51, 0.70, respectively). Simultaneously adjusting for all main exposures demonstrated that higher BP was independently associated with higher LVMI (SBP β = 5.64, 95 % CI: 2.78, 8.49; DBP β = 7.29, 95 % CI: 2.26, 12.31, for every 10 mmHg increase in BP).

Conclusions: Among a younger and incident hemodialysis population, higher systolic, diastolic, or pulse pressure, regardless of timing with dialysis, is most associated with higher LV mass. Future studies should consider the use of various BP measures in examining the impact of BP on LVM and cardiovascular disease. Findings from such studies could suggest that high BP should be more aggressively treated to promote LVH regression in incident hemodialysis patients.

No MeSH data available.


Related in: MedlinePlus