#2470 Isolated diastolic hypertension in hemodialysis patients

Abstract

Abstract Background and Aims Isolated diastolic hypertension (IDH) is relatively rare in the general population (prevalence about 6.5%, Front Cardiovasc Med. 2021;8:810105) and of uncertain etiologic implications. The prevalence of this alteration in the hemodialysis (HD) population and the etiologic implications of IDH have not been studied. Method We investigated the prevalence and the risk for all-cause death and cardiovascular events of isolated diastolic hypertension in a population of 534 HD patients enrolled in 7 centres in 3 European countries (the EURECA-m working group). BP was measured by a golden standard method in this population (48 h ABPM) using well-validated instruments (AAMI/ESH/ISO). Along with recommendations by the European Society of Hypertension guidelines, recordings were made at 15-minute intervals during the day and 30 minutes at night. According to a consensus document by the EURECAm working group (Nephrol Dial Transplant. 2019;34:1542-1548), isolated diastolic hypertension was defined as 48 h diastolic BP > 80 mmHg with a systolic BP <130. Results Among 534 HD patients, thirty-one (5.8%) had isolated diastolic HTN, which is very close to the prevalence estimated in the general population (6.5%). During a mean follow-up of 2.6 years, 138 patients died, 188 had at least one CV event, and 249 experienced the combined event. In univariate analyses, diastolic hypertension was associated with death (HR 0.21; 95% CI: 0.05-0.86, P = 0.03) and the combined outcome of death and CV events (HR 0.42, 95% CI: 0.20-0.88, P = 0.02). However, these associations were no longer significant after adjustment for age and sex (all P > 0.45). Additional sensitivity analyses substantially confirmed these findings. No effect modification by age or gender was observed in these associations. Conclusion In a large cohort of HD patients studied by state-of-the-art 48-hour BP monitoring, the prevalence of isolated diastolic hypertension in HD patients (5.8%) is close to that registered in the general population (6.5%). This alteration predicts the risk for clinical outcomes in unadjusted analyses but not after adjustment for age and sex. Isolated diastolic hypertension is as rare as it is in the general population and unlikely to contribute to the high risk of adverse clinical outcomes in the dialysis population.