Correlation Between The Morning Hypertension And Cardiovascular And Cerebrovascular Events In Patients With Maintenance Hemodialysis

Backgroud and ObjectiveThe number of patients on maintenance hemodialysis(MHD)keeps increasing throughout the world recently.It has already reached to 270,000 in China presently with steady high mortality.Cardio-cerebro-vascular events(CCVEs)are the most common causes of death and complications for patients on MHD.Hypertension plays key roles in the initiation and aggravation of CCVEs.Ambulatory blood pressure monitoring(ABPM)can reflect the BP levels and changes of the whole day directly,which is much more meaningful than office BP as for offering more information on diagnosis,therapeutic efficacy and prognosis of hypertension.Recently,some of novel concepts of the phenomena on BP changes were introduced: morning blood pressure surge(MBPS),blood pressure variability(BPV),the circadian BP rhythm,nocturnal hypertension,etc.Morning hypertension means the significant increasing of BP(>140/90 mm Hg)after waking up,and both high values of MBPS and long-standing high BP levels all night long until morning are included,which is about 44.6%~54% of the MHD patients.Clinical studies have found that MH is a crucial risk factor for CCVEs of hypertensive patients.However,different researches draw different conclusions.Nowadays the associations between MH and CCVEs,as well as its prognosis in MHD patients are poorly reported.To analyze the relationship between MH and CCVEs and to provide some evidence on prevention and control of CCVEs in MMD patients.Methods Clinical data of 190 hypertensive patients on MHD were collected.44h-ABPM were performed to All the patients and the incidence rate of MH were calculated.The patients were divided into 2 groups with the occurrence of MH: morning hypertension group(MH group)and non-morning hypertension group(NMH group).Then MH group was categorized into 3 subgroups: sustained group,no-sustained group and surged group.Analyze and compare the baseline clinical materials and data of lab examination between the MH and NMH groups.2 years’ follow-up were conducted in this prospective cohort study,both the incidence rate of CCVEs and mortality were calculated and be compared among different groups.The correlation between MH and CCVEs was analyzed and compared.Results190 patients were included totally,with male 113(54.2%)in all,77(40.5%)and 113(59.5%)in MH and NMH group.174 patients completed the follow-up in whole process,while the rest dropped out.In MH group,there were 16(14.2%),76(67.3%)and 21(18.5%)patients in surged group,sustained group and no-sustained group respectively.After 2 years’ follow-up,174 patients completed follow-up,and 16 patients were lost for various reasons.The differences of baseline clinical materials between the MH and NMH groups were not significant.Compared with the NMH group,the incidence rate of morning systolic BP,weight increase intra-hemodialysis,sleep disorder,CCVEs and mortality were higher in MH group(P<0.05),while it’s lower as an aspect of Kt/V(P<0.05).The sustained group experienced the highest incidence rate of CCVEs and mortality was of no significance among the 3 subgroups(P<0.05).The cumulative incidence rate of CCVEs in the MH group was significantly higher than NMH group.Morining systolic BP levels have significantly positive correlation with CCVEs in MH group(r=0.7,p<0.01),while it didn’t manifest this relationship in NMH group(r=0.2,P>0.05).Conclusions(1)Hypertensive patients on MHD suffer more from MH,especially the sustained type.(2)MH has strongly positive correlation with both CCVEs and mortality in MHD patients,which is impossible an important risk factor of them.