Abstract 243: Echocardiographic Changes of Left Ventricular Geometry and Function Associated with Reverse Epidemiology of Blood Pressure in End Stage Kidney Disease.
Background: We hypothesize that reverse epidemiology of blood pressure (BP) defined as higher mortality associated with lower BP in ESKD is partially mediated by deteriorating left ventricular (LV) function and configuration.
Methods: In a prospective observation 2136 patient-visits from 88 consecutive eligible prevalent ESKD patients on peritoneal dialysis from a single center between 2007 and 2012 were assessed. Monthly clinic BP was recorded. Routinely performed 285 interpretable serial echocardiograms were obtained. Patients were followed to primary end-point of all-cause mortality. Generalized linear mixed models using BP from last observation moving backward to assess trends, and time to event analysis using time varying Cox-survival models to estimate mortality hazard ratio of different BP categories were applied.
Results: There were 47 males (53.4%). Mean age was 50 years (SD=15). Median follow up was 35 months. During follow up 22 patients (25%) died. As compared to BP of 140-159 mmHg, BP<120 mmHg was associated with 8.6-fold (95% CI: 1.8-40, P=0.006) higher mortality. As compared to survivors who did not show any change, in deceased patients systolic BP (SBP) declined to a statistically lower level 9 months prior to death (117 vs 141 mmHg, P<0.05), left ventricular mass index (LVMI) increased by 40% from 83 to 128 g/m2, EF<50% increased by 30%, and concentric left ventricular hypertrophy (LVH) decreased by 20% at the expense of a 20% reciprocal increase in eccentric LVH. After adjusting for LVMI, risk of mortality at SBP<120 mmHg decreased to 4.4 (95% CI: 0.8 to 24, P=0.09).
Conclusion: Higher mortality with lower BP was likely mediated by worsening heart function.
Author Disclosures: F. Afshinnia: None. J.H. Segal: None.
- © 2014 by American Heart Association, Inc.