Blood pressure influences the occurrence of complex ventricular arrhythmia in hemodialysis patients

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 26; no. 6; pp. 1200 - 1203
• Main Authors: DE LIMA, J. J. G, LOPES, H. F, GRUPI, C. J, ABENSUR, H, GIORGI, M. C. P, KRIEGER, E. M, PILEGGI, F
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Philadelphia, PA Lippincott 01-12-1995; Hagerstown, MD American Heart Association, Inc
• Subjects: Adult; Aged; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - epidemiology; Biological and medical sciences; Blood Pressure; Echocardiography; Electrocardiography, Ambulatory; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Humans; Intensive care medicine; Logistic Models; Male; Medical sciences; Middle Aged; Prevalence; Renal Dialysis; Systole; Time Factors; Ventricular Function, Left - physiology
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/01.hyp.26.6.1200

We investigated the relationship between blood pressure and the occurrence of complex ventricular arrhythmias (multiform, couplets, or runs) as assessed by 48-hour Holter monitoring in 74 stable long-term hemodialysis patients (44.5 +/- 12 years old; 54% men; 74% whites; dialysis duration, 51.3 +/- 36.1 months; systolic pressure, 146.6 +/- 19.3 mm Hg; diastolic pressure, 89.2 +/- 12.1 mm Hg; prevalence of arterial hypertension, 33.8%). Systolic and diastolic pressures represented the average of all predialysis determinations during the 3 months preceding the tests. Hemodialysis was performed midway through the Holter monitoring period. M-mode and bidimensional echocardiograms and myocardial perfusion tests were also obtained from all patients. Complex arrhythmias were observed in 37 individuals (50%). Univariate analysis showed that systolic pressure (P < .001), diastolic pressure (P < .05), age (P < .001), left ventricular posterior wall thickness (P < .01), left ventricular mass index (P < .05), and ischemic alterations on myocardial perfusion tests (P < .005) were significantly associated with complex arrhythmias. With the use of a multivariate model (stepwise logistic regression analysis) only systolic pressure (P < .01) and age (P < .05) were independently associated with complex arrhythmias. Sex; angina; dialysis duration; New York Heart Association functional class; use of digitalis; plasma levels of creatinine, sodium, potassium, calcium, and phosphate; hematocrit; left ventricular fractional shortening; left ventricular diastolic diameter; and ST segment deviation were not correlated with complex arrhythmias. The severity and frequency of complex arrhythmias were not influenced by hemodialysis. At follow-up (5 to 80 months) 5 patients had died of sudden death, 4 of whom were hypertensive and older than 45 years.