4.7 Article

Blood Pressure and Risk of Cardiovascular Events in Patients on Chronic Hemodialysis The CRIC Study (Chronic Renal Insufficiency Cohort)

Journal

HYPERTENSION
Volume 70, Issue 2, Pages 435-+

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/HYPERTENSIONAHA.117.09091

Keywords

blood pressure; dialysis; heart failure; renal dialysis; stroke

Funding

  1. Chronic Renal Insufficiency Cohort Study
  2. National Institute of Diabetes and Digestive and Kidney Diseases [U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902]
  3. Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award National Institutes of Health (NIH)/National Center for Advancing Translational Sciences (NCATS) [UL1TR000003, K01 DK092353]
  4. Johns Hopkins University [UL1 TR-000424]
  5. University of Maryland General Clinical Research Center [M01 RR-16500]
  6. Clinical and Translational Science Collaborative of Cleveland
  7. NCATS component of the NIH and NIH roadmap for Medical Research [UL1TR000439]
  8. Michigan Institute for Clinical and Health Research [UL1TR000433]
  9. University of Illinois at Chicago Clinical and Translational Science Award [UL1RR029879]
  10. Tulane Centers of Biomedical Research Excellence for Clinical and Translational Research in Cardiometabolic Diseases [P20 GM109036]
  11. Kaiser Permanente NIH/National Center for Research Resources University of California
  12. San Francisco-Clinical Translational Science Institute [UL1 RR-024131]
  13. [K23 DK088865]
  14. [R01 DK70939]
  15. [K24 DK92291]

Ask authors/readers for more resources

We recently reported a linear association between higher systolic blood pressure (SBP) and risk of mortality in hemodialysis patients when SBP is measured outside of the dialysis unit (out-of-dialysis-unit-SBP), despite there being a U-shaped association between SBP measured at the dialysis unit (dialysis-unit-SBP) with risk of mortality. Here, we explored the relationship between SBP with cardiovascular events, which has important treatment implications but has not been well elucidated. Among 383 hemodialysis participants enrolled in the prospective CRIC study (Chronic Renal Insufficiency Cohort), multivariable splines and Cox models were used to study the association between SBP and adjudicated cardiovascular events (heart failure, myocardial infarction, ischemic stroke, and peripheral artery disease), controlling for differences in demographics, cardiovascular disease risk factors, and dialysis parameters. Dialysis-unit-SBP and out-of-dialysis-unit-SBP were modestly correlated (r=0.34; P < 0.001). We noted a U-shaped association of dialysis-unit-SBP and risk of cardiovascular events, with the nadir risk between 140 and 170 mm Hg. In contrast, there was a linear stepwise association between out-of-dialysis-unit-SBP with risk of cardiovascular events. Participants with out-of-dialysis-unit-SBP >= 128 mm Hg (top 2 quartiles) had >2-fold increased risk of cardiovascular events compared with those with out-of-dialysis-unit-SBP <= 112 mm Hg (3rd SBP quartile: adjusted hazard ratio, 2.08 [95% confidence interval, 1.12-3.87] and fourth SBP quartile: adjusted hazard ratio, 2.76 [95% confidence interval, 1.42-5.33]). In conclusion, among hemodialysis patients, although there is a U-shaped (paradoxical) association of dialysis-unit-SBP and risk of cardiovascular disease, there is a linear association of out-of-dialysis-unit-SBP with risk of cardiovascular disease. Out-of-dialysis-unit blood pressure provides key information and may be an important therapeutic target.

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