Relationships between blood pressure variability and left ventricular parameters in haemodialysis and renal transplant patients

Blood pressure (BP) elevation and left ventricular hypertrophy (LVH) are 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 transplantation. 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 transplants was undertaken. We also retrospectively compiled biochemical and clinical data. There were strong relationships between both diurnal and standard deviation measures of BPV and left ventricular cavity size and function: per cent fall in awake to asleep diastolic BP with fractional 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 reduced diurnal and short-term BP variability is,cross-sectionally associated with a dilated, heavier left ventricle (LV) with worse systolic function. Thus, BPV may independently contribute to the abnormal LV structure and function commonly seen in uraemia.