Relationship of Ambulatory Blood Pressure Monitoring Data to Echocardiographic Findings in Hemodialysis Patients

Cho, Jin Man; Kang, Heung Sun; Lee, Tae Won; Choue, Chung Whee; Kim, Kwon Sam; Song, Jung Sang; Bae, Jong Hoa

Abstract

BACKGROUND: Mortality and morbidity of the patients with chronic renal failure frequently related to cardiovascular disease, especially to Hypertension. The present study was performed to assess the value of arnbulatory blood pressure(ABP) monitoring in determining the adequacy of blood pressure(BP) control, and its relationship to echocardiographic findings in hemodialysis (HD) patients. SUBJECT AND METHODS: Twenty adult patients who had been on regular hemodialysis treatment for median duration of 23 rnonths were studied. 24 hour ABP monitoring was performed using a non-invasive ABP monitor. All of the study population were non diabetic. Casual BP (CBP) was defined as the average of two measurements obtained at two HD sessions, one preceding and the one following the ABP recordings, and was calculated for both the predialysis and postdialysis phases. Cardiac echocardiography was performed in each patient to determine interventricular septal thickness(IVS), left ventricular posterior wall thickness(LVPW), left ventricular fractional shortening(FS), and left ventricular mass index(LVMI).
RESULTS
1) 17(85%) of patients showed left ventricular hypertrophy in echocardiography. LVMI was positively correlated with systolic BP load(r=0.45, p<0.05). But, the correlation between LVMI and diastolic BP load was not statistically significant. 2) IVS shoved positive correlation to 24hr systolic and diastolic blood pressure load, but LVPW did not show correlation to any subset of 24h-ABP monitoring data except daytime sysrolic BP load. 3) LVMI showed correlation to day-time systolic BP load, but it did not show correlation to night-time BP load. 4) Casual BP did not show correlation to echocardiographic data.
CONCLUSIONS
These results suggest that 24hr ABP monitoring is more useful and accurate method than CBP to determine the degree of LVH and control of blood pressure in hemo- dialysis patients with hyertension.