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Integrated Central Blood Pressure-aortic Stiffness Risk Categories and Cardiovascular Mortality in End-stage Renal Disease
Artery Research volume 25, pages 49–55 (2019)
Abstract
Background
Our aim was to study the predictive power of integrated central blood pressure-aortic stiffness (ICPS) risk categories on cardiovascular (CV) mortality in end-stage renal disease (ESRD) patients.
Methods
This is a secondary analysis of a prospective study of 91 ESRD patients on hemodialysis therapy. At baseline, pulse wave velocity (PWV), central systolic blood pressure (cSBP) and central pulse pressure (cPP) were measured and patients were followed up for CV mortality for a median 29.5 months. Based on the shape of the association of each individual ICPS parameter with the CV outcome, patients were assigned ICPS scores: one point was given, if either the cSBP value was in the 3rd, or if the PWV or cPP was in the 2nd or 3rd tertiles (ICPS range: 0–3). We then evaluated the role of ICPS risk categories (average: 0–1, high: 2, very high: 3 points) in the prediction of CV outcomes using Cox proportional hazard regression analysis and compared its discrimination (Harrell’s C) to that of each of its components.
Results
We found a strong dose—response association between ICPS risk categories and CV outcome (high risk HR = 2.62, 95% CI: 0.82–8.43, p for trend = 0.106; very high risk HR = 10.03, 95% CI: 1.67–60.42, p = 0.02) even after adjustment for multiple potential confounders. ICPS risk categories had a modest discrimination (C: 0.622, 95% CI: 0.525–0.719) that was significantly better than that of cSBP (dC: 0.061, 95% CI: 0.006–0.117).
Conclusion
The ICPS risk categories may improve the identification of ESRD patients with high CV mortality risk.
References
Wheeler DC. Cardiovascular disease in patients with chronic renal failure. Lancet 1996;348:1673–4.
Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999;99:2434–9.
Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007;28:1462–536.
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013;34:2159–219.
Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016;37:2315–81.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018;39:3021–104.
Nemcsik J, Cseprekál O, Tislér A. Measurement of arterial stiffness: a novel tool of risk stratification in hypertension. Adv Exp Med Biol 2017;956:475–88.
Sági B, Késői I, Késői B, Vas T, Csiky B, Kovács T, et al. Arterial stiffness may predict renal and cardiovascular prognosis in autosomal-dominant polycystic kidney disease. Physiol Int 2018;105:145–56.
Nemcsik J, Tabák Á, Batta D, Cseprekál O, Egresits J, Tislér A. Integrated central blood pressure–aortic stiffness risk score for cardiovascular risk stratification in chronic kidney disease. Physiol Int 2018;105:335–46.
Nemcsik J, Egresits J, El Hadj Othmane T, Fekete BC, Fodor E, Szabó T, et al. Validation of arteriograph - a new oscillometric device to measure arterial stiffness in patients on maintenance hemodialysis. Kidney Blood Pressure Res 2009;32:223–9.
Németh ZK, Studinger P, Kiss I, El Hadj Othmane T, Nemcsik J, Fekete BC, et al. The method of distance measurement and torso length influences the relationship of pulse wave velocity to cardiovascular mortality. Am J Hypertens 2011;24:155–61.
El Hadj Othmane T, Nemcsik J, Fekete BC, Deák G, Egresits J, Fodor E, et al. Arterial stiffness in hemodialysis: which parameter to measure to predict cardiovascular mortality? Kidney Blood Pressure Res 2009;32:250–7.
Speer G, Fekete BC, El Hadj Othmane T, Szabó T, Egresits J, Fodor E, et al. Serum osteoprotegerin level, carotid-femoral pulse wave velocity and cardiovascular survival in haemodialysis patients. Nephrol Dial Transplant 2008;23:3256–62.
Salvi P, Lio G, Labat C, Ricci E, Pannier B, Benetos A. Validation of a new non-invasive portable tonometer for determining arterial pressure wave and pulse wave velocity: the PulsePen device. J Hypertens 2004;22:2285–93.
Van Bortel LM, Laurent S, Boutouyrie P, Chowienczyk P, Cruickshank JK, De Backer T, et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens 2012;30:445–8.
Cseprekál O, Egresits J, Tabák Á, Nemcsik J, Járai Z, Babos L, et al. The significance of micro- and macrovascular biomarkers on cardiovascular outcome in chronic kidney disease: a prospective cohort study. J Hum Hypertens 2016;30:449–55.
Nemcsik J, Kiss I, Tislér A. Arterial stiffness, vascular calcification and bone metabolism in chronic kidney disease. World J Nephrol 2012;1:25–34.
Niiranen TJ, Kalesan B, Mitchell GF, Vasan RS. Relative contributions of pulse pressure and arterial stiffness to cardiovascular disease. Hypertension 2019;73:712–17.
Fagard RH. Predicting risk of fatal cardiovascular disease and sudden death in hypertension. J Hypertens 2017;35:2165–7.
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Highlights
· Integrated evaluation of central blood pressure and stiffness (ICPS) may improve risk prediction.
· ICPS risk categories were developed and tested in end-stage renal disease (ESRD).
· Very high ICPS risk category is a strong predictor of cardiovascular mortality in ESRD.
Peer review under responsibility of the Association for Research into Arterial Structure and Physiology
Data availability statement: The data that support the findings of this study are available from the corresponding author, upon reasonable request.
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This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).
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Batta, D., Tabák, Á., Kőrösi, B. et al. Integrated Central Blood Pressure-aortic Stiffness Risk Categories and Cardiovascular Mortality in End-stage Renal Disease. Artery Res 25, 49–55 (2019). https://doi.org/10.2991/artres.k.191114.004
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DOI: https://doi.org/10.2991/artres.k.191114.004