RELATIONSHIPS BETWEEN BLOOD-PRESSURE VARIABILITY AND LEFT-VENTRICULARPARAMETERS IN HEMODIALYSIS AND RENAL-TRANSPLANT PATIENTS

Blood pressure (BP) elevation and left ventricular hypertrophy (LVH) a re important factors in the high cardiovascular mortality on the renal replacement programme. The relationship between these, predictable in essential hypertension, is less well defined in uraemia. We wished to examine the contribution of abnormal blood pressure variability (BPV) to the cardiovascular changes seen in uraemia and after renal transpl antation. Twenty-four hour ambulatory blood pressure monitoring (ABPM) , and simultaneous echocardiography, on a cohort of 35 long-term, long -hours haemodialysis survivors and 28 patients with stable renal trans plants was undertaken. We also retrospectively compiled biochemical an d clinical data. There were strong relationships between both diurnal and standard deviation measures of BPV and left ventricular cavity siz e and function: per cent fall in awake to asleep diastolic BP with fra ctional shortening index (FSI), r=0.28, P=0.039; with left ventricular mass index (LVMI), r= -0.35, P=0.011. This study suggests that reduce d diurnal and short-term BP variability is,cross-sectionally associate d with a dilated, heavier left ventricle (LV) with worse systolic func tion. Thus, BPV may independently contribute to the abnormal LV struct ure and function commonly seen in uraemia.