Haginoshita S, Sakurabayashi T, Miyazaki S, Saito N, Koda Y,
et al
Blood pressure control prevents left ventricular
hypertrophy and reduces cardiovascular mortality in long-term
hemodialysis patients
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1513 1996
Cardiovascular complications explain a significant proportion of deaths in
ESRD. Both high and low BP have been assosicated with mortality. LVH is an
independent risk for death. LVH is associated with high blood pressure and
hematocrits under 30%. Whether LVH will regress under good BP control or a
sustained maintenance of hematocrit has not been demonstrated.
These authors retrospectively review 59 patients who have survived at
least
10 years on hemodialysis. BP control between the 7th and 10th year was
correlated with left ventricular mass index (as defined by ECHO). Patients
with an LVMindex > 178g/M^2 had a higher incidence of cardiovascular
death
(p < .01, Kaplan-Meier) than those patients with a lesser LVMindex.
Patients with systolic blood pressures in the high normal (142 +/- 9) had a
higher LVMindex than patients with normal systolic BP (113 /- 11). There
was no difference in dialysis adequacy, creatinine, or hematocrits between
the
two groups.
Comment: The authors only identify cardiovascular death and not all
cause death, so the
comparative survival of the two groups is not stated in the abstract. They
do not state whether there was a differential survival between the mild
hypertensives and the normotensives. This is a rather unique group of
patients. Long term survival beyond the 10th year of hemodialysis has to
be generalizable to a very small segment of the US ESRD population. It is
implied that BP control is responsible for the absence of LVH. It is not
stated in the abstract whether the patients in the normotensive group were
normotensive with or without medication. The authors do not specify what
BP they are measuring. The abstract does not state if there was any
"regression" of LVH nor what medications were used.
(Peter B. DeOreo MD, Case Western Reserve University, Cleveland)
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Am Soc Nephrol
CRF by organ system :
Cardiovascular/Hypertension
CRF: Problem Areas :
Outcomes (Morbidity, Mortality)