Francesca Mallamaci1,2, Rocco Tripepi1, Claudia Torino1, Giovanni Tripepi1, Pantelis Sarafidis3, Carmine Zoccali4,5,6. 1. CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy. 2. Divisione di Nefrologia e, Trapianto Renale Grande Ospedale Metropolitano, Reggio Calabria, Italy. 3. Department of Nephrology, Aristotle University of Thessaloniki, Thessaloniki, Greece. 4. Renal Research Institute, New York, USA. carmine.zoccali@tin.it. 5. Associazione Ipertensione Nefrologia e Trapianto Renale (IPNET), Reggio Calabria, Italy. carmine.zoccali@tin.it. 6. IPNET C/o CNR-IFC and Nefrologia Grande Ospedale Metropolitano, Reggio Calabria, Italy. carmine.zoccali@tin.it.
Abstract
INTRODUCTION: An exaggeration of the early morning increase in BP, a phenomenon accompanied by a parallel rise in heart rate (HR), is a marker of high cardiovascular risk. The early morning changes in these parameters have not been investigated in the hemodialysis population. METHODS: In a pilot, single center study including a series of 58 patients we measured the pre-awakening BP and HR surges and the nocturnal dipping of the same parameters as well as other established indicators of autonomic function (weighted 24 h systolic BP and HR variability) and tested their relationship with the left ventricular mass index (LVMI) and with the risk of death over a median follow up of 40 months. RESULTS: The pre-awakening HR surge (r = - 0.46, P = 0.001) but not the corresponding BP surge (r = - 0.1, P = 0.98) was associated with LVMI and the risk of death [HR (1 unit): 0.89, 95% CI 0.83-0.96, P = 0.001]. The link between the pre-awakening HR surge with these outcome measures was robust and largely independent of established risk factors in the hemodialysis population, including the nocturnal dipping of BP. Weighted 24 h systolic BP and HR variability did not correlate with LVMI (all P > 0.11) nor with the risk of death (P > 0.11) and were also independent of the nocturnal dipping of systolic BP and HR. CONCLUSION: This pilot study suggests that the low early morning changes in HR, likely reflecting enhanced sympathetic activity, entail a high risk for left ventricular hypertrophy (LVH) and mortality in the hemodialysis population.
INTRODUCTION: An exaggeration of the early morning increase in BP, a phenomenon accompanied by a parallel rise in heart rate (HR), is a marker of high cardiovascular risk. The early morning changes in these parameters have not been investigated in the hemodialysis population. METHODS: In a pilot, single center study including a series of 58 patients we measured the pre-awakening BP and HR surges and the nocturnal dipping of the same parameters as well as other established indicators of autonomic function (weighted 24 h systolic BP and HR variability) and tested their relationship with the left ventricular mass index (LVMI) and with the risk of death over a median follow up of 40 months. RESULTS: The pre-awakening HR surge (r = - 0.46, P = 0.001) but not the corresponding BP surge (r = - 0.1, P = 0.98) was associated with LVMI and the risk of death [HR (1 unit): 0.89, 95% CI 0.83-0.96, P = 0.001]. The link between the pre-awakening HR surge with these outcome measures was robust and largely independent of established risk factors in the hemodialysis population, including the nocturnal dipping of BP. Weighted 24 h systolic BP and HR variability did not correlate with LVMI (all P > 0.11) nor with the risk of death (P > 0.11) and were also independent of the nocturnal dipping of systolic BP and HR. CONCLUSION: This pilot study suggests that the low early morning changes in HR, likely reflecting enhanced sympathetic activity, entail a high risk for left ventricular hypertrophy (LVH) and mortality in the hemodialysis population.
Authors: Gianfranco Parati; Juan Eugenio Ochoa; Grzegorz Bilo; Rajiv Agarwal; Adrian Covic; Friedo W Dekker; Danilo Fliser; Gunnar H Heine; Kitty J Jager; Luna Gargani; Mehmet Kanbay; Francesca Mallamaci; Ziad Massy; Alberto Ortiz; Eugenio Picano; Patrick Rossignol; Pantelis Sarafidis; Rosa Sicari; Raymond Vanholder; Andrzej Wiecek; Gerard London; Carmine Zoccali Journal: Hypertension Date: 2016-05-02 Impact factor: 10.190