PS 08-43] THE PATTERNS OF AMBULATORY BLOOD PRESSURE IS QUITE DIFFERENT IN PATIENTS WITH END-STAGE RENAL DISEASE ACCORDING TO DIALYSIS MODALITY

Abstract

Objective: Since accurate assessment of blood pressure (BP) is essential to control BP adequately, ambulatory blood pressure monitoring (ABPM) is widely used for estimation of BP status and has prognostic significance in patients with hypertension including end-stage renal disease (ESRD). Although the ABPM patterns might be distinguished due to the inherent characteristics of dialysis modality, there has been lacking evidences until now. Therefore, the aim of this study was to elucidate difference of ABPM parameters and pattern according to dialysis modality. Design and Method: Patients were prospectively enrolled by Cardiovascular and Metabolic Disease Etiology Research center (CMERC) of Yonsei University College of Medicine between November 2013 and August 2015. We analyzed the differences of baseline characteristics, office BPs, ABPM parameters and ABPM patterns (dipper, non-dipper and reverse dipper) in ESRD patients according to dialysis modality. Results: Among a total of 174 patients, 109 (62.6%) were hemodialysis (HD) patients and 65 (37.4%) were peritoneal dialysis (PD) patients. 155 (89.1%) patients had hypertension, 96 (89.2%) in HD and 59 (90.8%) in PD. All measured diastolic BP (DBP) and 24 hours mean arterial pressure (MAP) were significantly higher in PD (office DBP, 24 h mean DBP, daytime DBP and night DBP; respectively p = 0.011, 0.006, 0.010 and 24 hours MAP; p = 0.047) compared to those in HD. The prevalence of non-dipper was higher in PD than HD (dipper vs non-dipper; 33.0% vs 39.4% in HD and 26.2% vs 47.7% in PD). Total number of antihypertensive medications was higher in PD than HD. Conclusions: ABPM patterns, DBP and 24 hours MAP in dialysis patients were significant different according to dialysis modality. Despite the effort for controlling BP by using more antihypertensive medications, BP control based on office BP is not satisfactory and adverse ABPM pattern is more prevalent in PD patients than HD.