Nephrol Dial Transplant (2003) 18: 563-569
© 2003 European Renal Association-European Dialysis and Transplant Association
Non-dipping is a potent predictor of cardiovascular mortality and is associated with autonomic dysfunction in haemodialysis patients
1 Division of Clinical Immunology, Department of Medicine, Nagoya University Graduate School of Medicine, Nagoya and 2 Department of Medicine, Nagoya Kyoritsu Hospital, Nagoya, Japan
Background. Lack of nocturnal blood pressure (BP) fall (non-dipping) is common among haemodialysis (HD) patients, but much less is known regarding its association with cardiovascular (CV) disease morbidity and mortality.
Methods. Eighty HD patients initially underwent 24 h ambulatory BP monitoring (ABPM), and then they were defined as either ‘dippers' (n=24, nocturnal BP fall 
10%) or ‘non-dippers' (n=56, fall <10%). Coronary angiography was performed in the patients who had signs and/or symptoms of coronary artery disease (CAD). Twenty-four hour ambulatory ECG was recorded in 20 dippers and 20 non-dipper HD patients, and in 20 normal subjects. All patients were followed for up to 5.8 years (33.0±19.1 months). The outcome events studied were the hospitalisations due to CV diseases and CV death.
Results. Compared with dippers, non-dippers initially had a higher incidence of coronary artery stenosis (P<0.05) along with left ventricular asynergy (both Ps<0.01). The circadian rhythm of autonomic function was impaired in non-dippers. The incidences of CV events and CV deaths were 3.5 and 9 times higher in non-dippers than in dippers. The cumulative CV event-free survival and CV survival rates were lower in non-dippers than in dippers (P=0.02 and P=0.005, respectively). Based on Cox analysis, non-dipping was associated positively with CV events and CV mortality [hazard ratio (HR) 2.46, 95% CI 1.02–5.92, P=0.038 and HR 9.62, 95% CI 1.23–75.42, P=0.031, respectively]. Meanwhile, nocturnal systolic BP fall, diurnal systolic BP and diurnal pulse pressure were negatively associated with CV event/death. The clinic BP was not associated with CV event/death.
Conclusions. The non-dipping phenomenon is closely related to a high incidence of CV diseases, a poor long-term survival and profound autonomic dysfunction. ABPM is useful in predicting long-term CV prognosis in HD patients.
Keywords: ambulatory blood pressure monitoring; cardiovascular diseases; cumulative survival; haemodialysis; heart rate variability; non-dipping
Correspondence and offprint requests to: Seiichi Matsuo, MD, Division of Clinical Immunology, Department of Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya 466-8550, Japan. Email: smatsuo{at}med.nagoya-u.ac.jp
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  G. V. da Silva, S. de Barros, H. Abensur, K. C. Ortega, D. Mion Jr, and Cochrane Renal Group Prospective Trial Register: C Home blood pressure monitoring in blood pressure control among haemodialysis patients: an open randomized clinical trial Nephrol. Dial. Transplant., July 8, 2009; (2009) gfp332v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Giacchetti, V. Ronconi, S. Rilli, M. Guerrieri, F. Turchi, and M. Boscaro Small tumor size as favorable prognostic factor after adrenalectomy in Conn's adenoma Eur. J. Endocrinol., April 1, 2009; 160(4): 639 - 646. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. S. Campbell, B. L. Key, A. D. Ireland, S. L. Bacon, and B. Ditto Early Socioeconomic Status is Associated With Adult Nighttime Blood Pressure Dipping Psychosom Med, April 1, 2008; 70(3): 276 - 281. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Chavanu, J. Merkel, and A. M. Quan Role of ambulatory blood pressure monitoring in the management of hypertension Am. J. Health Syst. Pharm., February 1, 2008; 65(3): 209 - 218. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Wuhl, C. Hadtstein, O. Mehls, F. Schaefer, and the ESCAPE Trial Group Ultradian but not Circadian Blood Pressure Rhythms Correlate with Renal Dysfunction in Children with Chronic Renal Failure J. Am. Soc. Nephrol., March 1, 2005; 16(3): 746 - 754. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Song, X. Hu, M. Shi, M. A. Knepper, and C. A. Ecelbarger Effects of dietary fat, NaCl, and fructose on renal sodium and water transporter abundances and systemic blood pressure Am J Physiol Renal Physiol, December 1, 2004; 287(6): F1204 - F1212. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. Amin, J. L. Carroll, J. L. Jeffries, C. Grone, J. A. Bean, B. Chini, R. Bokulic, and S. R. Daniels Twenty-four-hour Ambulatory Blood Pressure in Children with Sleep-disordered Breathing Am. J. Respir. Crit. Care Med., April 15, 2004; 169(8): 950 - 956. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Hadtstein, E. Wuhl, M. Soergel, K. Witte, F. Schaefer, and the German Study Group for Pediatric Hypertension Normative Values for Circadian and Ultradian Cardiovascular Rhythms in Childhood Hypertension, March 1, 2004; 43(3): 547 - 554. [Abstract] [Full Text] [PDF]
|
|