维持性血液透析患者高血压影响因素的分析

目的:统计南京军区南京总医院解放军肾脏病研究所血液净化中心188例患者血压控制情况,分析影响高血压控制的因素.方法:维持性血液透析(MHD)超过3个月的患者188例进行回顾性分析.根据血压,将188例患者分为血压正常组(A组)、血压达标组(B组)、血压未达标组(C组),分析MHD患者透析高血压的影响因素.统计参数包括一般资料;实验室及透析相关参数:透析时间、透析剂量、超滤量、体重变化、血红蛋白(Hb)、电解质水平、尿素氮清除率(Kt/V)等.结果:(1)55.3％的血压控制未达标,其中单纯收缩压、舒张压升高者分别为47.1％、1.9％;(2)三组患者的年龄、性别构成、千体重无明显差异;C组的体重增长率、体重增长过多者的比例、促红细胞生成素(EPO)剂量、钙磷乘积明显较前两组高,透析龄、Hb、Kt/V较前两组低,差异有统计学意义(P＜0.05).经Logistic回归分析(step),透析前收缩压与Hb、Kt/V成负相关,与EPO剂量、钙磷乘积呈正相关.(3)体重增长率和血压的平稳性紧密相关,体重增长率＜0.03及体重增长率＞0.03的平均收缩压下降率分别为0.049±0.104和0.206±0.165,统计学差异显著(P＜0.05).结论:MHD患者合并高血压者较为常见,其中以收缩压升高为主;高血压的控制受多种因素影响,包括体重增长率、体重增长过多者的比例、EPO剂量、透析龄、Hb、Kt/V等.透析前收缩压与Hb、Kt/V及透析龄呈负相关,与EPO剂量呈正相关,未发现与年龄有明显相关性.     

老年维持性血液透析患者透析间期血压节律的影响因素分析

目的探讨老年维持性血液透析（MHD）患者透析间期动态血压节律的影响因素。方法选择28例老年MHD患者,均于透析间期进行24h动态血压监测,同时完善血液生化指标和心脏超声检查。根据动态血压监测中夜间收缩压下降率情况将患者分为2组：血压节律正常组和血压节律异常组。采用独立样本t检验或Fisher确切概率法比较两组患者一般情况、血液生化指标、动态血压参数、心脏结构及功能的差异;采用多因素Logistic回归分析老年MHD患者透析间期血压节律的影响因素。结果（1）血压节律异常组甲状旁腺激素水平、动态动脉硬化指数、对称性动态动脉硬化指数、左室质量指数高于血压节律正常组（P〈0．05）,差异有统计学意义。（2）多因素Logistic回归分析结果显示,甲状旁腺激素、对称性动念动脉硬化指数、左室肥大是动态血压节血律异常的独立危险因素。结论继发性甲状腺机能亢进、动脉硬化、左室肥大是老年MHD患者透析间期动态血压节律异常的独立危险因素。     

维持性血液透析患者的血压与透析充分性及相关因素分析

目的观察维持性血液透析(MHD)患者血压与透析充分性及其它相关因素间的关系。方法 56例MHD连续12次记录透析前后血压、体重、超滤量(FV),分别计算收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)的均值,第0、1、2、3个月透析前后测定血液生化值、甲状旁腺激素(PTH)、血红蛋白(Hb)、红细胞压积(Hct),计算尿素清除指数(Kt/V)、尿素下降率(URR)。结果透析充分组(Kt/V≥1.2、URR≥0.65)MHD患者血压明显低于透析不充分组(Kt/V<1.2、URR<0.65)差异有统计学意义(P<0.05);Hct≥0.22组与Hct<0.22组比较MAP差异有统计学意义(P<0.05);Logistic回归分析显示透析间期体重增加量、体重增加率、透析不充分及血清PTH水平与透析前收缩压密切相关(OR=1.98~3.50,P<0.05)。结论充分透析、减少容量负荷是控制MHD患者高血压的关键,透析不充分、透析间期体重增长过多、高血清甲状旁腺激素水平与透析前收缩压升高有密切关系。     

高龄老年人血压变异性与踝臂指数关系探讨

目的评价高龄老年人群血压变异性(BPV)与踝臂指数(ABI)的关系。方法入选年龄≥80岁高龄老人111例,按照ABI分为异常ABI组(ABI≤0.9或ABI>1.3)56例和正常ABI组(ABI>0.9)55例,比较2组24h动态血压参数和BPV参数;另根据血压将患者分为高血压组48例和非高血压组63例,观察2组BPV及ABI差异。logistic回归分析ABI独立危险因素。结果异常ABI组较正常ABI组24h舒张压、昼间舒张压和夜间舒张压明显降低(P<0.05),24h收缩压变异性[(12.80±2.66)mm Hg(1mm Hg=0.133kPa)vs(14.14±3.64)mm Hg]明显降低、夜间收缩压变异性[(11.99±4.19)mm Hg vs(9.97±4.05)mm Hg]明显增高(P<0.05)。高血压组24h收缩压变异性[(14.87±3.91)mm Hg vs(13.20±3.41)mm Hg]、夜间收缩压变异性[(12.27±5.50)mm Hg vs(10.33±3.93)mm Hg]明显增高,ABI[(0.98±0.21)vs(1.07±0.20)]明显降低(P<0.05)。logistic回归分析提示,夜间舒张压和夜间收缩压变异性为ABI的独立危险因素(P<0.05)。结论高龄老年人群24h舒张压、昼间及夜间舒张压、24h收缩压变异性、夜间收缩压变异性可能是异常ABI的危险因素。     

成年人体重10年变化与血压关系的探讨

目的对成年人体重10年间的动态变化及其它因素与血压关系的探讨,进一步阐明体重对血压的影响.方法采用整群抽样的方法,在1983-1984年对调查人群进行心血管病及心肺疾病危险因素的基线调查,于1993-1994年对队列人群再次进行随访调查,共调查男性2083人、女性2576人.结果无论男女,10年后体重、BMI、收缩压、舒张压均值都比10年前高(P<0.01);体重的不同变化对血压的影响不同,体重增加组收缩压,舒张压增加均值大于体重不变及体重减轻组,差异有极显著性,体重不变及体重减轻组之间收缩压,舒张压增加均值无明显差异;在控制年龄后,偏相关分析结果显示基线体重(BMI)、随访体重(BMI)、体重(BMI)变化均与收缩压、舒张压水平呈正相关;多元逐步回归分析结果显示,对收缩压有影响的自变量是年龄、家族史、随访体重、随访BMI,对舒张压有影响的自变量则是家族史、年龄、随访体重、随访BMI和基线BMI.结论体重的增长与血压升高关系密切,采取有效方式控制体重的增长是防止血压升高的重要手段之一.     

老年患者24h动态血压监测及血压变异性与踝臂指数的相关性分析

目的探讨老年患者24 h动态血压监测及血压变异性(blood pressure variability,BPV)与踝臂指数(ankle-brachial index,ABI)之间的相关性。方法选择于2014年1月至2015年8月来广州市番禺区中心医院就诊的65~80岁老年患者220例,按照ABI数值将所有老年人分为正常ABI组(ABI0.9)和异常ABI组(ABI≤0.9或ABI1.3),其中正常ABI组121例,异常ABI组119例。比较两组患者24 h动态血压参数和BPV参数。按照血压高低将患者分为高血压组(95例)和非高血压组(125例),分析比较两组BPV参数及ABI差异。采用Logistic回归分析法分析ABI的独立危险因素。结果高血压组24 h收缩压BPV、夜间收缩压BPV明显高于非高血压组,差异有统计学意义(P0.05)。异常ABI组24 h舒张压、白天舒张压、夜间舒张压、24 h收缩压BPV明显低于正常ABI组,夜间收缩压BPV明显高于正常ABI组,差异有统计学意义(P0.05)。Logistic回归分析结果显示,夜间舒张压、夜间收缩压BPV是ABI的独立危险因素。结论老年患者的舒张压、夜间舒张压、夜间收缩压BPV是影响ABI的独立危险因素,BPV与ABI明显相关,平稳控制血压对延缓动脉硬化的发生有一定影响。     

维持性血液透析患者血清ADMA水平影响因素分析

目的 分析影响维持性血液透析(MHD)患者血清非对称性二甲基精氨酸(ADMA)水平的因素.方法 选择行MHD的终末期肾脏病(ESRD)患者126例,记录年龄、性别、吸烟、糖尿病、透析龄、透前收缩压、舒张压.采用高效液相色谱-质谱联用法(HPLC-MS)测定血清ADMA浓度.提取全血DNA,用Snapshot基因测序法确定DDAH-2(-449G/C)单核苷酸基因多态性.将血清ADMA水平与各变量之间进行统计分析.结果 DDAH-2(-449G/C)基因型GG、CG、CC患者血清ADMA浓度差异无统计学意义(P＞0.05);血压升高、长透析龄、透前收缩压升高、胆固醇升高患者的ADMA水平较高(P均＜0.05).经多元线性回归分析,透析龄、透前收缩压及血清总胆固醇水平是影响血清ADMA水平的独立危险因素.结论 透析龄、透前收缩压及血清总胆固醇水平是影响行MHD患者血清ADMA水平的独立危险因素.DDAH-2(-449G/C)单核苷酸基因的多态性可能对中国行MHD患者的ADMA水平无影响作用.     

成年人体重10年变化与血压关系的探讨

目的　对成年人体重 10年间的动态变化及其它因素与血压关系的探讨 ,进一步阐明体重对血压的影响。方法采用整群抽样的方法 ,在 1983 -1984年对调查人群进行心血管病及心肺疾病危险因素的基线调查 ,于 1993 -1994年对队列人群再次进行随访调查 ,共调查男性 2 0 83人、女性 2 576人。结果　无论男女 ,10年后体重、BMI、收缩压、舒张压均值都比 10年前高 (P <0 0 1) ;体重的不同变化对血压的影响不同 ,体重增加组收缩压 ,舒张压增加均值大于体重不变及体重减轻组 ,差异有极显著性 ,体重不变及体重减轻组之间收缩压 ,舒张压增加均值无明显差异 ;在控制年龄后 ,偏相关分析结果显示基线体重 (BMI)、随访体重 (BMI)、体重 (BMI)变化均与收缩压、舒张压水平呈正相关 ;多元逐步回归分析结果显示 ,对收缩压有影响的自变量是年龄、家族史、随访体重、随访BMI ,对舒张压有影响的自变量则是家族史、年龄、随访体重、随访BMI和基线BMI。结论　体重的增长与血压升高关系密切 ,采取有效方式控制体重的增长是防止血压升高的重要手段之一。     

老年高血压患者血浆同型半胱氨酸与血压变异性的关系

目的:研究老年高血压患者血浆同型半胱氨酸(HCY)与24h血压变异性(BPV)之间的关系。方法:随机选取2015年10月至2016年11月,在北京安贞医院高血压科住院的老年高血压患者217例,根据HCY水平将患者分为两组:高HCY组(HCY>15.0μmol/L)115例及正常HCY组(HCY≤15.0μmol/L)102例。所有患者均行24h动态血压监测,计算24h收缩压及舒张压的变异系数,比较两组患者年龄、体质指数、血肌酐、血脂、空腹血糖、HCY、24h收缩压及舒张压的变异系数,并分析血压变异性与HCY的相关性。结果:高HCY组患者的年龄、空腹血糖、肌酐、HCY水平、24h收缩压变异系数和24h舒张压变异系数明显高于正常HCY组[(70.81±5.65)vs.(68.39±5.70)岁、(5.68±0.66)vs.(5.50±0.57)mmol/L、(81.13±19.80)vs.(72.38±13.85)μmol/L、(16.9±1.43)vs.(10.09±2.21)μmol/L、(11.57±2.33)vs.(10.51±2.31)、(11.74±2.46)vs.(10.47±2.08)],差异有统计学意义(P<0.05);老年高血压患者24h收缩压变异系数与HCY呈正相关(P<0.05);24h舒张压变异系数与HCY、CHO呈正相关,与HDL-C呈负相关(P<0.05)。结论:老年高血压患者24h动态血压变异系数与血浆HCY水平正相关,血浆HCY升高可能是BPV升高的危险因素之一。     

昼夜动态血压变化与脑白质疏松症的关系

目的探讨昼夜动态血压变化与脑白质疏松症(LA)的相关性。方法回顾性分析脑血管病危险因素筛查研究中的144例患者,根据头部MRI结果分为LA组(80例)和非LA组(64例)。采用美国DP5000型动态血压监测仪监测患者的血压水平,包括昼夜收缩压(24 hSBP)、昼夜舒张压(24 hDBP)、白昼收缩压(DSBP)、白昼舒张压(DDBP)、夜晚收缩压(NSBP)、夜晚舒张压(NDBP);血压变异性(BPV)参数包括白昼收缩压标准差(DSBP-SD)和舒张压标准差(DDBP-SD)、夜晚收缩压标准差(NSBP-SD)和舒张压标准差(NDBP-SD)。根据DSBP和NSBP判定血压昼夜节律,同时比较两组动态血压参数以及血压昼夜节律分型的差异。结果①LA组昼夜SBP、DSBP、DDBP、NSBP、DSBP-SD高于非LA组,差异有统计学意义(P<0.05)。②非杓型和超杓型患者的LA发生率高于杓型患者(63.0%和68.4%比38.5%),差异有统计学意义(P<0.05)。③Binary Logistic回归分析显示,DSBP(OR=1.070;95%CI:1.024～1.117)和DSBP-SD(OR=1.324;95%CI:1.129～1.552)增高是LA的独立危险因素。结论血压水平、血压变异性及血压昼夜节律是LA的重要影响因素,其中DSBP、DSBP-SD增高是LA的独立危险因素。     

Two Variable Sodium Profiles and Adverse Effects During Hemodialysis: A Randomized Crossover Study

Intradialytic symptomatic hypotension and muscle cramps are frequent and disturbing adverse effects involving hemodialysis patients. The use of sodium profiling has been a proposed approach to preclude such events. The aim of the study was to compare the frequency of intradialytic adverse effects and changes in anthropometric and physiological variables without profiling and with two distinct sodium profiles. A prospective study randomized 22 stable hemodialysis patients to receive either a step (11 patients) or a linear (11 patients) dialysate sodium profile for 12 consecutive sessions, following a 12-session steady sodium control period. After a wash-out period of 12 sessions, the groups were crossed over for another 12-session period. Frequency of adverse effects, interdialytic weight gain, pre- and post-dialysis blood pressure were computed. The frequency of intradialytic adverse effects was significantly different between the control and either the step or linear periods (48.5%, 33.7%, and 36.0%, respectively; P < 0.001). No significant differences in interdialytic weight gain or pre-dialysis blood pressure were detected between treatment periods. The mean post-dialysis systolic blood pressure was lower in the linear period (128 ± 21; 127 ± 20; 123 ± 22 mm Hg, for the control, step and linear periods, respectively; P = 0.014). Seven patients benefited from sodium profiling, yet two became more symptomatic. Overall, both sodium profiles were associated with fewer intradialytic adverse effects. Intradialytic symptomatic hypotension occurred less often with the step profile, while a tendency to fewer cramps was associated with the linear profile. However, sodium profiling may not benefit every dialysis patient and should be individually evaluated.     

The effect of an L/N-type calcium channel blocker on intradialytic blood pressure in intradialytic hypertensive patients

Background: Intradialytic hypertension (HTN), which is one of the poor prognostic markers in patients undergoing hemodialysis, may be associated with sympathetic overactivity. The L/N-type calcium channel blocker, cilnidipine, has been reported to suppress sympathetic nerves activity in vivo. Therefore, we hypothesized that cilnidipine could attenuate intradialytic systolic blood pressure (SBP) elevation. Methods: Fifty-one patients on chronic hemodialysis who had intradialytic-HTN (SBP elevation ≥10 mmHg during hemodialysis) and no fluid overload were prospectively randomized into two groups: control and cilnidipine groups. Cilnidipine group patients took cilnidipine (10 mg/day) for 12 weeks. The primary endpoint was the change in the intradialytic SBP elevation before and after the 12-week intervention. Results: Before the intervention, no differences were observed in age, sex or pre-dialytic SBP (148.5 ± 12.9 vs. 148.3 ± 19.3 mmHg) between the two groups. Intradialytic SBP elevation was unchanged in the control group. Cilnidipine significantly lowered the post-dialytic SBP with an attenuation of the intradialytic SBP elevation from 12.0 ± 15.4 mmHg to 4.8 ± 10.1 mmHg. However, the observed difference in the intradialytic SBP elevation by cilnidipine did not reach statistical significance (group×time interaction effect p = 0.25). Cathecolamine levels were unaffected by the intervention in both groups. Conclusion: Cilnidipine lowers both the pre- and post-dialytic SBP and might attenuate intradialytic SBP elevation. Therefore, cilnidipine may be effective in lowering SBP during HD in patients with intradialytic-HTN.     

Impact of Dialysate Sodium Concentration Lowering on Home Blood Pressure Variability in Hemodialysis Patients

Blood pressure variability is an independent risk factor for mortality and cardiovascular events in hemodialysis patients. Dialysate sodium concentration may not only have effects on blood pressure but also on blood pressure variability. We investigated whether dialysate sodium concentration lowering could decrease home blood pressure variability in hemodialysis patients. Forty‐three hemodialysis patients at their dry weight assessed by bioimpedance methods with pre‐dialysis serum sodium >136 mmol/L were recruited. Firstly, patients underwent a 1‐month standard dialysis with dialysate sodium concentration of 138 mmol/L, and then the dialysate sodium concentration was decreased to 136 mmol/L for 8 weeks. Home blood pressure was assessed on waking up and at bedtime for 1 week. Coefficient of variation was used to define home blood pressure variability. After the intervention, whole‐day systolic blood pressure variability decreased from 5.7 ± 2.6% to 4.3 ± 1.7% and evening systolic blood pressure variability decreased from 7.9 ± 4.1% to 6.2 ± 3.1%. Morning systolic blood pressure variability had a reduction from 7.8 ± 2.4% to 5.9 ± 3.3% but did not achieve statistical significance (P = 0.077). Whole‐day, morning and evening systolic blood pressure were decreased significantly. Less changes were observed in diastolic blood pressure parameters. Interdialytic weight gain mildly but significantly decreased. Volume parameters, dietary sodium intake and incidence of adverse events were similar throughout the study period. Lowering dialysate sodium concentration could improve home blood pressure variability among hemodialysis patients who had achieved their dry weight.     

Aliskiren Reduces Morning Blood Pressure in Hypertensive Patients with Diabetic Nephropathy on Hemodialysis

Our previous study indicated that the exchange from an angiotensin receptor blocker (ARB) to aliskiren reduced morning blood pressure and albuminuria in hypertensive patients with diabetic nephropathy. We extended the above study and assessed the effects of exchanging from an ARB to aliskiren on home blood pressure in hypertensive patients with diabetic nephropathy on chronic hemodialysis. The patients who were persistently hypertensive despite antihypertensive therapy, including ARB, were considered as candidates for the exchange from the ARB to aliskiren. Patients’ age and durations of diabetes and hemodialysis were averaged as 62 ± 9 years old, 15 ± 8 and 7 ± 3 years, respectively. Aliskiren decreased morning systolic blood pressure (149 ± 14 to 144 ± 13 mm Hg, n = 30, P < .01) and plasma renin activity (3.5 ± 1.1 to 1.2 ± 0.6 ng/mL/h, P < .01) without changes in serum potassium. Aliskiren also reduced interdialytic weight gain (2.7 ± 0.6 to 2.5 ± 0.5 kg/interval, P < .05) and attenuated the magnitude of intradialytic declines in systolic (?20 ± 11 to ?17 ± 10 mm Hg, P < .05) and diastolic blood pressure (?9 ± 6 to ?5 ± 5 mm Hg, P < .01). The exchange from an ARB to aliskiren is safe and useful to control home blood pressure in hypertensive hemodialysis patients with diabetic nephropathy. Aliskiren reduced both intradialytic blood pressure drops and interdialytic weight gain in patients with DN.     

Forecast post-dialysis blood pressure in hemodialysis patients with intradialytic hypertension

Background: Intradialytic hypertension (IDH) is emerging as an important issue in maintenance hemodialysis (MHD) patients. This study aimed to discuss potential factors related to IDH and build forecasting models for post-dialysis blood pressure (BP) in MHD patients with IDH.

Methods: A total of 266 MHD patients were enrolled, included 133 (50%) patients with IDH and 133 patients without IDH. The BP and pulse were determined and recorded over six consecutive dialysis treatments. Forecasting models were established by simple and multiple linear regressions. The Pearson correlation coefficient was used to estimate the association between the values of SBP at pre-HD, intra-HD and post-HD.

Results: Lower levels of hemoglobin, albumin, folic acid and magnesium, higher levels of high sensitivity C-reactive protein, ferritin, and erythropoiesis-stimulating agents resistance index (ERI) were detected in the IDH patients. The IDH patients also had lower dry weight, ejection fraction of left ventricular (LVEF), higher interdialytic weight gain (IDWG, % post-HD body weight), and ventricular cardiothoracic ratio (CTR) than non-IDH patients. A linear relationship was revealed between intradialytic SBP in IDH patients, indicating that the pre-HD and intra-HD SBP were correlated with post-HD SBP. Furthermore, simple and multiple linear regression models were built to forecast the values of post-HD SBP in IDH patients.

Conclusions: The chronic inflammation, poor IDWG control, LV diastolic dysfunction, as well as low serum folic acid and magnesium might be associated with increasing prevalence of IDH in MHD patients. Forecasting models for post-HD SBP could help to control hypertension during HD treatments.     

Association of Serum Uric Acid Level With Blood Pressure Variability in Newly Diagnosed Essential Hypertension

Serum uric acid (UA) is independently associated with hypertension and blood pressure (BP) variability (BPV) is associated with cardiovascular events and mortality in hypertensive patients. The aim of the present study was to assess the association of serum UA with BPV in 300 untreated essential hypertension patients (mean age 57.3±13.6 years). BPV was quantified as the standard deviation (SD) of the 24‐hour, daytime, and nighttime mean values obtained by using ambulatory BP monitoring. In correlation analysis, log UA values were found to be positively correlated with 24‐hour systolic BPV and nighttime systolic and diastolic BPV (Pearson coefficients of 0.246, 0.280, and 0.353, respectively; P<.001 for all). In multivariate analysis, log UA had an independent association with 24‐hour systolic BPV and nighttime systolic and diastolic BPV. This study show for the first time that increased serum UA is independently associated with BPV in untreated essential hypertension patients.     

Effects of Sodium Concentration and Dialysate Temperature Changes on Blood Pressure in Hemodialysis Patients: A Randomized,Triple‐Blind Crossover Clinical Trial

The present study investigated the effects of different temperatures and sodium dialysate concentration on blood pressure in hemodialysis patients. Following Williams’ design, hemodialysis patients were randomly assigned into four dialysis modes. Dialysate temperature was set at 37°C for modes A and C and, 35°C for modes B and D. Sodium concentration was set at 138 mmol/L in modes A and B, while it changed from 150 mmol/L to 138 mmol/L in modes C and D. Using analysis of variance for repeated measures, the mean values of systolic and diastolic blood pressure were investigated. The mean values of systolic and diastolic blood pressure in modes C and D had a significant difference with the values in mode A. The mean values of systolic and diastolic blood pressure in patients dialyzed with mode B had a significant difference with the values in those dialyzed with mode D. Moreover, there were significant differences in the incidence of hypotension between A and other modes and between B and modes C and D, but this difference was not significant between modes C and D. In order to reduce intradialytic blood pressure fluctuations and hypotension, the nursing staff are recommended to gradually reduce dialysate sodium concentration.     

Effect of Improving Volume Overload on Home Blood Pressure Variability in Hemodialysis Patients

Blood pressure variability is an independent predictor of adverse clinical events in hemodialysis patients. Volume overload is one of the most important factors affecting blood pressure homeostasis. In the present study, we explored the effects of dry weight reduction on home blood pressure variability in volume overload hemodialysis patients. Hemodialysis patients with volume overload had their dry weight gradually decreased under the guidance of bioimpedance methods, which was represented by calf‐bioimpedance ratio (Calf‐BR). Home blood pressure was measured on waking up and at bedtime for 1 week at baseline and at the end of the two‐month study. Coefficient of variation was used to define home blood pressure variability. Thirty‐eight hemodialysis patients had their dry weight significantly decreased from 60.7 ± 11.3 to 59.6 ± 10.7 kg (P = 0.003) accompanied with a significant reduction in calf‐BR (0.828 ± 0.023 vs. 0.786 ± 0.020, P<0.001). The systolic and diastolic blood pressure decreased significantly. Moreover, the whole‐day, morning, and evening systolic blood pressure variability gradually and significantly decreased by the end of the study (5.6 ± 2.1% versus 4.0 ± 1.7%, P<0.001; 7.7 ± 3.5% vs. 6.3 ± 2.7%, P = 0.005; 7.5 ± 2.8% vs. 5.9 ± 2.3%, P = 0.002, respectively). Diastolic blood pressure variability parameters were unchanged. The interdialytic weight gain and the incidence of adverse events were similar throughout the study period. Gradual dry weight reduction by bioimpedance methods improved home blood pressure variability in hemodialysis patients with chronic fluid overload.     

Home Blood Pressure Control After the Great East Japan Earthquake in Patients on Chronic Hemodialysis

At 14:46 on 11 March 2011, northeastern Japan was struck by a major earthquake measuring 9.0 on the Richter scale (the Great East Japan Earthquake). Several reports have suggested a transient blood pressure (BP) increase after a major earthquake, but its impact on BP in chronic dialysis patients has not been reported. In a retrospective review of 25 hemodialysis patients who were residents of Koriyama City, changes in the morning home BP after the earthquake were investigated. Home systolic and diastolic BPs were significantly elevated 1 week after the earthquake (158 ± 16 mm Hg vs. 151 ± 13 mm Hg, P < 0.01, for systolic; 81 ± 13 mm Hg vs. 78 ± 11 mm Hg, P = 0.01, for diastolic). Mean home BP 1 week after the earthquake was unchanged from baseline in patients treated with sympatholytics and/or renin‐angiotensin system (RAS) inhibitors. BP values returned to baseline by 4 weeks after the earthquake, but percent changes in mean BP were significantly greater even 2 weeks, 4 weeks, and 6 weeks after the earthquake in patients not treated with RAS inhibitors than in those treated with RAS inhibitors (2 weeks 7.0% ± 4.5% vs. 0.2% ± 5.0%, P < 0.01; 4 weeks 4.4% ± 5.9% vs. ?1.8% ± 5.3%, P = 0.02; 6 weeks 4.6% ± 4.9% vs. ?1.9% ± 3.9%, P < 0.01). On multiple regression analysis, RAS inhibitor use had an independent relationship with percentage increases in mean BP during the 6 weeks after the earthquake. Home BP was significantly increased after a major earthquake in patients on chronic hemodialysis. Prolonged deterioration of BP control after the earthquake was associated with non‐use of RAS inhibitors.