Long-term blood pressure monitoring and echocardiographic findings in patients with end-stage renal disease: Reverse epidemiology explained?

H. Borsboom, L. Smans, M. J.M. Cramer, J. C. Kelder, M. P. Kooistra, P. F. Vos, B. C. van Jaarsveld

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: In patients with end-stage renal disease (ESRD) hypertension is common and often leads to left ventricular (LV) hypertrophy and diastolic dysfunction, but hypotension at the onset of dialysis is associated with increased mortality. We studied blood pressure data over longer periods of time in patients on haemodialysis and related them to echocardiographic outcome, in order to elucidate these contradictory findings. Methods: In 50 haemodialysis patients mean arterial pressure (MAP) and pulse pressure (PP) were calculated in the first three months of haemodialysis, the complete period from the start of haemodialysis until echocardiography and the last three months of haemodialysis before echocardiography. Hypertension load, pulse pressure and interdialytic weight gain were quantified and related to echocardiography. Results: LV mass index was associated with MAP in all three periods, and also with the hypertension load, PP and PP load. In patients with LV dilatation, MAP and PP averaged over the complete period of dialysis were 5 to 7 mmHg higher than in patients without LV dilatation. Blood pressure parameters were the same in patients with or without LV diastolic dysfunction or systolic dysfunction. Systolic dysfunction was more frequent in patients undergoing long-term haemodialysis treatment. Interdialytic weight gain was not associated with any of the echocardiographic variables. Conclusion: When long-term blood pressure values are considered, hypertension is associated with parameters of early cardiac damage such as increased LV mass index and not with parameters of advanced heart failure such as systolic dysfunction. This supports the hypothesis that the presence of advanced heart failure reciprocally influences blood pressure in a negative way, thereby explaining the 'reverse epidemiology' of blood pressure and mortality in ESRD.

Original languageEnglish
Pages (from-to)399-406
Number of pages8
JournalNetherlands Journal of Medicine
Volume63
Issue number10
Publication statusPublished - 1 Nov 2005

Cite this

Borsboom, H. ; Smans, L. ; Cramer, M. J.M. ; Kelder, J. C. ; Kooistra, M. P. ; Vos, P. F. ; van Jaarsveld, B. C. / Long-term blood pressure monitoring and echocardiographic findings in patients with end-stage renal disease : Reverse epidemiology explained?. In: Netherlands Journal of Medicine. 2005 ; Vol. 63, No. 10. pp. 399-406.
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title = "Long-term blood pressure monitoring and echocardiographic findings in patients with end-stage renal disease: Reverse epidemiology explained?",
abstract = "Background: In patients with end-stage renal disease (ESRD) hypertension is common and often leads to left ventricular (LV) hypertrophy and diastolic dysfunction, but hypotension at the onset of dialysis is associated with increased mortality. We studied blood pressure data over longer periods of time in patients on haemodialysis and related them to echocardiographic outcome, in order to elucidate these contradictory findings. Methods: In 50 haemodialysis patients mean arterial pressure (MAP) and pulse pressure (PP) were calculated in the first three months of haemodialysis, the complete period from the start of haemodialysis until echocardiography and the last three months of haemodialysis before echocardiography. Hypertension load, pulse pressure and interdialytic weight gain were quantified and related to echocardiography. Results: LV mass index was associated with MAP in all three periods, and also with the hypertension load, PP and PP load. In patients with LV dilatation, MAP and PP averaged over the complete period of dialysis were 5 to 7 mmHg higher than in patients without LV dilatation. Blood pressure parameters were the same in patients with or without LV diastolic dysfunction or systolic dysfunction. Systolic dysfunction was more frequent in patients undergoing long-term haemodialysis treatment. Interdialytic weight gain was not associated with any of the echocardiographic variables. Conclusion: When long-term blood pressure values are considered, hypertension is associated with parameters of early cardiac damage such as increased LV mass index and not with parameters of advanced heart failure such as systolic dysfunction. This supports the hypothesis that the presence of advanced heart failure reciprocally influences blood pressure in a negative way, thereby explaining the 'reverse epidemiology' of blood pressure and mortality in ESRD.",
keywords = "Echocardiography, End-stage renal disease, Haemodialysis, Heart failure, Left ventricular hypertrophy",
author = "H. Borsboom and L. Smans and Cramer, {M. J.M.} and Kelder, {J. C.} and Kooistra, {M. P.} and Vos, {P. F.} and {van Jaarsveld}, {B. C.}",
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Long-term blood pressure monitoring and echocardiographic findings in patients with end-stage renal disease : Reverse epidemiology explained? / Borsboom, H.; Smans, L.; Cramer, M. J.M.; Kelder, J. C.; Kooistra, M. P.; Vos, P. F.; van Jaarsveld, B. C.

In: Netherlands Journal of Medicine, Vol. 63, No. 10, 01.11.2005, p. 399-406.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Long-term blood pressure monitoring and echocardiographic findings in patients with end-stage renal disease

T2 - Reverse epidemiology explained?

AU - Borsboom, H.

AU - Smans, L.

AU - Cramer, M. J.M.

AU - Kelder, J. C.

AU - Kooistra, M. P.

AU - Vos, P. F.

AU - van Jaarsveld, B. C.

PY - 2005/11/1

Y1 - 2005/11/1

N2 - Background: In patients with end-stage renal disease (ESRD) hypertension is common and often leads to left ventricular (LV) hypertrophy and diastolic dysfunction, but hypotension at the onset of dialysis is associated with increased mortality. We studied blood pressure data over longer periods of time in patients on haemodialysis and related them to echocardiographic outcome, in order to elucidate these contradictory findings. Methods: In 50 haemodialysis patients mean arterial pressure (MAP) and pulse pressure (PP) were calculated in the first three months of haemodialysis, the complete period from the start of haemodialysis until echocardiography and the last three months of haemodialysis before echocardiography. Hypertension load, pulse pressure and interdialytic weight gain were quantified and related to echocardiography. Results: LV mass index was associated with MAP in all three periods, and also with the hypertension load, PP and PP load. In patients with LV dilatation, MAP and PP averaged over the complete period of dialysis were 5 to 7 mmHg higher than in patients without LV dilatation. Blood pressure parameters were the same in patients with or without LV diastolic dysfunction or systolic dysfunction. Systolic dysfunction was more frequent in patients undergoing long-term haemodialysis treatment. Interdialytic weight gain was not associated with any of the echocardiographic variables. Conclusion: When long-term blood pressure values are considered, hypertension is associated with parameters of early cardiac damage such as increased LV mass index and not with parameters of advanced heart failure such as systolic dysfunction. This supports the hypothesis that the presence of advanced heart failure reciprocally influences blood pressure in a negative way, thereby explaining the 'reverse epidemiology' of blood pressure and mortality in ESRD.

AB - Background: In patients with end-stage renal disease (ESRD) hypertension is common and often leads to left ventricular (LV) hypertrophy and diastolic dysfunction, but hypotension at the onset of dialysis is associated with increased mortality. We studied blood pressure data over longer periods of time in patients on haemodialysis and related them to echocardiographic outcome, in order to elucidate these contradictory findings. Methods: In 50 haemodialysis patients mean arterial pressure (MAP) and pulse pressure (PP) were calculated in the first three months of haemodialysis, the complete period from the start of haemodialysis until echocardiography and the last three months of haemodialysis before echocardiography. Hypertension load, pulse pressure and interdialytic weight gain were quantified and related to echocardiography. Results: LV mass index was associated with MAP in all three periods, and also with the hypertension load, PP and PP load. In patients with LV dilatation, MAP and PP averaged over the complete period of dialysis were 5 to 7 mmHg higher than in patients without LV dilatation. Blood pressure parameters were the same in patients with or without LV diastolic dysfunction or systolic dysfunction. Systolic dysfunction was more frequent in patients undergoing long-term haemodialysis treatment. Interdialytic weight gain was not associated with any of the echocardiographic variables. Conclusion: When long-term blood pressure values are considered, hypertension is associated with parameters of early cardiac damage such as increased LV mass index and not with parameters of advanced heart failure such as systolic dysfunction. This supports the hypothesis that the presence of advanced heart failure reciprocally influences blood pressure in a negative way, thereby explaining the 'reverse epidemiology' of blood pressure and mortality in ESRD.

KW - Echocardiography

KW - End-stage renal disease

KW - Haemodialysis

KW - Heart failure

KW - Left ventricular hypertrophy

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M3 - Article

VL - 63

SP - 399

EP - 406

JO - Netherlands Journal of Medicine

JF - Netherlands Journal of Medicine

SN - 0300-2977

IS - 10

ER -