BLOOD-PRESSURE INFLUENCES THE OCCURRENCE OF COMPLEX VENTRICULAR ARRHYTHMIA IN HEMODIALYSIS-PATIENTS

We investigated the relationship between blood pressure and the occurrence of complex ventricular arrhythmias (multiform, couplers, or runs) as assessed by 48-hour Holter monitoring in 74 stable long-term hemodialysis patients (44.5+/-12 years old; 54% men; 74% whites; dialysis duration, 51.3+/-36.1 months systolic pressure, 146.6+/-19.3 mm Hg; diastolic pressure, 89.2+/-12.1 mm Hg; prevalence of arterial hypertension, 33.8%). Systolic and diastolic pressures represented the average of all predialysis determinations during the 3 months preceding the tests. Hemodialysis was performed midway through the Holter monitoring period. M-mode and bidimensional echocardiograms and myocardial perfusion tests were also obtained from all patients. Complex arrhythmias were observed in 37 individuals (50%). Univariate analysis showed that systolic pressure (P<.001), diastolic pressure (P<.05), age (P<.001), left ventricular posterior wall thickness (P<.01), left ventricular mass index (P<.05), and ischemic alterations on myocardial perfusion rests (P<.005) were significantly associated with complex arrhythmias. With the use of a multivariate model (stepwise logistic regression analysis) only systolic pressure (P<.01) and age (P<.05) were independently associated with complex arrhythmias. Sex; angina; dialysis duration; New York Heart Association functional class; use of digitalis; plasma levels of creatinine, sodium, potassium, calcium, and phosphate; hematocrit; left ventricular fractional shortening; left ventricular diastolic diameter; and ST segment deviation were not correlated with complex arrhythmias. The severity and frequency of complex arrhythmias were not influenced by hemodialysis. At follow-up (5 to 80 months) 5 patients had died of sudden death, 4 of whom were hypertensive and older than 45 years. We conclude that complex ventricular arrhythmias are highly prevalent in long-term hemodialysis patients, their occurrence is independently influenced by systolic pressure and age, and they are not aggravated by dialysis itself in this stable dialysis population. The data also suggest that Holter monitoring should be performed in elderly hypertensive dialysis patients.