DeLima JJG, Lopes HF, Grupi CH, Abensur H, Giorgi MCP, Krieger EM, Pileggi F
Blood pressure influences the occurrence of complex ventricular arrhythmia in hemodialysis patients

Hypertension (Dec) 26:1200-1203 1995

Morbidity and mortality due to cardiac disease in the end stage renal disease population are clearly the predominant factors affecting outcome in this group of patients. This paper from Brazil studies the prevalence of dysrhythmias in a hemodialysis population. The 74 stable, longterm patients were markedly unusual relative to the United States experience in that only 3 were diabetic. After 48 hours of Holter monitoring pre-, during, and post dialysis it was determined that "complex ventricular arrhythmias" occurred in 50% of the study group. However, the prognostic significance of these dysrhythmias is open to debate as nearly half of them were simple couplets, the remaining being multifocal PVCs and runs of VT. Only age and systolic blood pressure were correlated with these dyrhythmias and the latter seemed to have a direct correlation to the Lown's classification of degree of ventricular arrhythmia. Diastolic blood pressure, left ventricular mass studies, and even ischemia on a dipyidamole-thalium study were not significant when corrected for "confounding factors" (unclearly defined). At the end of the 5-80 month follow up period the authors found 5 patients had died a sudden death. They conclude that routine Holter monitoring may be useful in elderly hypertensive dialysis patients but fail to recognize that the information obtained is not only of unclear significance prognostically, but also cannot be remedied by proven therapeutic interventions available to the clinician. (Narsipur)

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CRF by organ system : Cardiovascular/Hypertension