Abstract
Objective: Ambulatory blood pressure (BP) control is worse in men than in women with chronic kidney disease (CKD) and this may partially explain the faster CKD progression in men. The aim of this study is to investigate possible sex-differences in ambulatory BP levels, BP trajectories, and BP variability (BPV) in hemodialysis patients. Design and method: 129 male and 91 female hemodialysis patients that underwent 48-h ABPM with Mobil-O-Graph-NG were included in this analysis. Ambulatory BP levels over the 2-day interdialytic interval (including two daytime and two nighttime periods) were recorded. We calculated the standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), and average real variability (ARV) of BP with validated formulas. Results: Age, dialysis vintage, antihypertensive treatment and history of major comorbidities did not differ between men and women. Pre-dialysis SBP levels did not differ between men and women (145.1 ± 22.7 vs 145.9 ± 25.7mmHg, p = 0.808), but DBP was marginally higher in men (87.6 ± 14.0 vs 84.0 ± 13.7mmHg, p = 0.055). 48-h SBP/DBP (137.2 ± 17.4/81.9 ± 12.1mmHg vs 132.2 ± 19.2/75.9 ± 11.7mmHg, p = 0.045/ < 0.001) as well as DBP during the 1st and SBP/DBP during the 2nd 24-h period were significantly higher in men than in women. Similarly, daytime SBP/DBP was significantly higher in men (138.3 ± 17.5/83.2 ± 12.3mmHg vs 131.9 ± 19.4/76.4 ± 11.5mmHg. p = 0.011/< 0.001). No significant between-group differences were detected for nighttime SBP. All SBP variability indices were similar between men and women; DBP-SD, DBP-wSD and DBP-ARV were higher in men (44-h DBP-ARV 9.4 ± 1.8 vs 8.6 ± 1.9, p = 0.002). No significant differences were revealed in the dipping pattern between men and women. Conclusions: Ambulatory BP levels and trajectories, as well as DBP variability indices are higher in men than women hemodialysis patients. This worse ambulatory BP profile in male compared to female patients may impact on the incidence of cardiovascular events.
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