ARTERIAL DISTENSIBILITY, CIRCADIAN BLOOD- PRESSURE PATTERN AND BLOOD-PRESSURE VARIABILITY IN PATIENTS WITH END-STAGE RENAL-DISEASE

An increased blood pressure variability (BVP) and a loss of nocturnal decline in BP could enhance cardiovascular disease. Peripheral resista nces and arterial compliance determine systolic BP. BVP could depend o n arterial stiffness. We tested this hypothesis in patients with end-s tage renal disease (ERSD) who have arterial elasticity impairment. Twe nty one ESRD patients (49.9 +/- 16.7 years) 12 mean and 9 women, under going maintenance hemodialysis were studied; 19 had treated hypertensi on. Ambulatory (ABP) monitoring was performed in all patients: BP was measured every 15 minutes in day-time and every 30 minutes at night. S ystolic diurnal variation coefficient was calculated as the ratio betw een standard deviation and the mean of systolic diurnal BP. Nycthemera l BP pattern was evaluated as the ratio between mean diurnal and noctu rnal systolic BP (N/D). Pulse wave velocity (PVW), an index of arteria l stiffness, was determined between carotid and femoral sites (11.6 +/ - 4.22 m/s). These investigations were performed after the midweek dia lysis session. We found a positive correlation between PVW and systoli c diurnal BPV (stepwise regression F = 12.9, p < 0.01). This correlati on was independant of hypertension, antihypertensive treatment, durati on of hemodialysis, and erythropoientin. We also found a positive corr elation between N/D and PWV (stepwise regression: F = 8.9 p < 0.05). O ur study shows that arterial distensibility links BPV and N/D. It is s uggested that an arterial distensibility impairment could enhance BPV and modify nycthemeral BP pattern.