Nephrol Dial Transplant (1999) 14: 1976-1981
© 1999 European Renal Association-European Dialysis and Transplant Association
Blood pressure variability as an adverse prognostic risk factor in end-stage renal disease
1 Third Department of Internal Medicine, and 2 Dialysis Unit, University of The Ryukyus, 3 Okinawa Dai-ichi Hospital, Okinawa, Japan
Correspondence and offprint requests to: Masahiko Tozawa MD, Third Department of Internal Medicine, University of The Ryukyus, 207 Uehara, Nishihara-cho, Okinawa 903–0215, Japan.
Background. Prospective and case-control studies show that blood-pressure variability is an independent risk factor for severe organ damage and cardiovascular events in hypertensives. We prospectively studied the association between systolic blood pressure variability and cardiovascular mortality and mortality from all causes in end-stage renal disease patients.
Methods and results. The subjects were 144 patients (86 men, 58 women; mean age±SD, 52±13 years) who underwent dialysis in the same dialysis centre and were examined for blood-pressure variability. The study period was 38 months beginning in January 1995, during which six cardiovascular and seven non-cardiovascular fatalities occurred. Coefficient of variation in systolic blood pressure in 1994, as an indicator of systolic blood pressure variability, ranged from 7.8 to 14.6%. Cumulative incidence of death from all causes was related to coefficient of variation in systolic blood pressure. The difference between the maximum and minimum systolic blood pressure (
SBP) in 1994 ranged from 44 to 146 mmHg (mean±SD, 78±13 mmHg) and correlated significantly with coefficient of variation in systolic blood pressure (r=0.65, P<0.0001). Cox regression analysis was used to identify the independent predictors for mortality. The hazard ratio for death from all causes increased 1.63 times per 1% increase in coefficient of variation in systolic blood pressure (hazard ratio; 95% confidence interval: 1.63; 1.05–2.53) and 1.03 times per 1 mmHg increase in SBP (1.08; 1.03–1.14).
Conclusion. These results suggest that systolic blood pressure variability may be a significant prognostic factor in end-stage renal disease.
Keywords: blood pressure; haemodialysis; kidney; risk factor; variability
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