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Blood Pressure and Mortality in the 4D Study.
Yazdani, Babak; Kleber, Marcus E; Delgado, Graciela E; Yücel, Gökhan; Asgari, Aruscha; Gerken, Andreas L H; Daschner, Clara; Ayasse, Niklas; März, Winfried; Wanner, Christoph; Krämer, Bernhard K.
Afiliación
  • Yazdani B; Fifth Department of Medicine, University Medical Center Mannheim UMM, Faculty of Medicine of the University of Heidelberg, Mannheim, Germany.
  • Kleber ME; Fifth Department of Medicine, University Medical Center Mannheim UMM, Faculty of Medicine of the University of Heidelberg, Mannheim, Germany.
  • Delgado GE; SYNLAB MVZ Humangenetik Mannheim, Mannheim, Germany.
  • Yücel G; Fifth Department of Medicine, University Medical Center Mannheim UMM, Faculty of Medicine of the University of Heidelberg, Mannheim, Germany.
  • Asgari A; Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
  • Gerken ALH; First Department of Medicine, University Medical Center Mannheim UMM, Faculty of Medicine of the University of Heidelberg, Mannheim, Germany.
  • Daschner C; Zahnarztpraxis Asgari and Kollegen, Frankfurt, Germany.
  • Ayasse N; Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
  • März W; Fifth Department of Medicine, University Medical Center Mannheim UMM, Faculty of Medicine of the University of Heidelberg, Mannheim, Germany.
  • Wanner C; Fifth Department of Medicine, University Medical Center Mannheim UMM, Faculty of Medicine of the University of Heidelberg, Mannheim, Germany.
  • Krämer BK; Fifth Department of Medicine, University Medical Center Mannheim UMM, Faculty of Medicine of the University of Heidelberg, Mannheim, Germany.
Kidney Blood Press Res ; 48(1): 678-687, 2023.
Article en En | MEDLINE | ID: mdl-37806305
INTRODUCTION: Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) are risk factors for cardiovascular mortality (CVM). Pulse pressure (PP) is an easily available parameter of vascular stiffness, but its impact on CVM in chronic dialysis patients with diabetes is unclear. METHODS: Therefore, we have examined the predictive value of baseline, predialytic PP, SBP, DBP, and MAP in the German Diabetes and Dialysis (4D) study, a prospective, randomized, double-blind trial enrolling 1,255 patients with type 2 diabetes on hemodialysis in 178 German dialysis centers. RESULTS: Mean age was 66.3 years, mean blood pressure 146/76 mm Hg, mean time suffering from diabetes 18.1 years, and mean time on maintenance dialysis 8.3 months. Considered as continuous variables, PP, MAP, SBP, and DBP could not provide a significant mortality prediction for either cardiovascular or all-cause mortality. After dividing the cohort into corresponding tertiles, we also did not detect any significant mortality prediction for PP, SBP, DBP, or MAP, both for all-cause mortality and CVM after adjusting for age and sex. Nevertheless, when comparing the HR plots of the corresponding blood pressure parameters, a pronounced U-curve was seen for PP for both all-cause mortality and CVM, with the trough range being 70-80 mm Hg. DISCUSSION: In patients with end-stage renal disease and long-lasting diabetes mellitus predialytic blood pressure parameters at study entry are not predictive for mortality, presumably because there is a very high rate of competing mortality risk factors, resulting in overall very high rates of all-cause and CVM that may no longer be significantly modulated by blood pressure control.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Diabetes Mellitus Tipo 2 / Hipertensión Tipo de estudio: Clinical_trials / Prognostic_studies / Risk_factors_studies Límite: Aged / Humans Idioma: En Revista: Kidney Blood Press Res Asunto de la revista: NEFROLOGIA Año: 2023 Tipo del documento: Article País de afiliación: Alemania

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Diabetes Mellitus Tipo 2 / Hipertensión Tipo de estudio: Clinical_trials / Prognostic_studies / Risk_factors_studies Límite: Aged / Humans Idioma: En Revista: Kidney Blood Press Res Asunto de la revista: NEFROLOGIA Año: 2023 Tipo del documento: Article País de afiliación: Alemania