(Circulation. 2001;103:987.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Impact of Aortic Stiffness Attenuation on Survival of Patients in End-Stage Renal Failure
From Service d’Hémodialyse (A.P.G., B.P., S.J.M., G.M.L.), Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne (J.B., M.E.S.), Hôpital Broussais, Paris, France.
Correspondence to Dr G.M. London, Hôpital F.H. Manhès, 8, Grande Rue, Fleury-Mérogis, 91712 Ste-Geneviève-des-Bois, Cedex, France. E-mail glondon{at}club-internet.fr
Background—Aortic pulse wave velocity (PWV) is a predictor of mortality in patients with end-stage renal failure (ESRF). The PWV is partly dependent on blood pressure (BP), and a decrease in BP can attenuate the stiffness. Whether the changes in PWV in response to decreases in BP can predict mortality in ESRF patients has never been investigated.
Methods and Results—One hundred fifty ESRF patients (aged 52±16 years) were monitored for 51±38 months. From entry until the end of follow-up, the changes of PWV in response to decreased BP were measured ultrasonographically. BP was controlled by adjustment of "dry weight" and, when necessary, with ACE inhibitors, calcium antagonists, and/or ß-blockers, in combination if necessary. Fifty-nine deaths occurred, including 40 cardiovascular and 19 noncardiovascular events. Cox analyses demonstrated that independent of BP changes, the predictors of all-cause and cardiovascular mortality were as follows: absence of PWV decrease in response to BP decrease, increased left ventricular mass, age, and preexisting cardiovascular disease. Survival was positively associated with ACE inhibitor use. After adjustment for all confounding factors, the risk ratio for the absence of PWV decrease was 2.59 (95% CI 1.51 to 4.43) for all-cause mortality and 2.35 (95% CI 1.23 to 4.41) for cardiovascular mortality. The risk ratio for ACE inhibitor use was 0.19 (95% CI 0.14 to 0.43) for all-cause mortality and 0.18 (95% CI 0.06 to 0.55) for cardiovascular mortality.
Conclusions—These results indicate that in ESRF patients, the insensitivity of PWV to decreased BP is an independent predictor of mortality and that use of ACE inhibitors has a favorable effect on survival that is independent of BP changes.
Key Words: kidney • waves • mortality • hypertension
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C. Giannattasio, F. Achilli, M. Failla, A. Capra, A. Vincenzi, F. Valagussa, and G. Mancia Radial, carotid and aortic distensibility in congestive heart failure: effects of high-dose angiotensin-converting enzyme inhibitor or low-dose association with angiotensin type 1 receptor blockade J. Am. Coll. Cardiol., April 17, 2002; 39(8): 1275 - 1282. [Abstract] [Full Text] [PDF]
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J. J. G. De Lima, M. L. C. Vieira, L. F. Viviani, C. J. Medeiros, L. E. Ianhez, L. Kopel, J. L. de Andrade, E. M. Krieger, and S. G. Lage Long-term impact of renal transplantation on carotid artery properties and on ventricular hypertrophy in end-stage renal failure patients Nephrol. Dial. Transplant., April 1, 2002; 17(4): 645 - 651. [Abstract] [Full Text] [PDF]
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J. Blacher and M. Safar Specific aspects of high blood pressure in the elderly Journal of Renin-Angiotensin-Aldosterone System, March 1, 2002; 3(1_suppl): S10 - S15. [PDF]
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S.E. Greenwald Pulse pressure and arterial elasticity QJM, February 1, 2002; 95(2): 107 - 112. [Full Text] [PDF]
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S. Meaume, A. Benetos, O.F. Henry, A. Rudnichi, and M.E. Safar Aortic Pulse Wave Velocity Predicts Cardiovascular Mortality in Subjects >70 Years of Age Arterioscler Thromb Vasc Biol, December 1, 2001; 21(12): 2046 - 2050. [Abstract] [Full Text] [PDF]
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G. M. London, B. Pannier, A. P. Guerin, J. Blacher, S. J. Marchais, B. Darne, F. Metivier, H. Adda, and M. E. Safar Alterations of Left Ventricular Hypertrophy in and Survival of Patients Receiving Hemodialysis: Follow-up of an Interventional Study J. Am. Soc. Nephrol., December 1, 2001; 12(12): 2759 - 2767. [Abstract] [Full Text] [PDF]
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T. SHOJI, M. EMOTO, K. SHINOHARA, R. KAKIYA, Y. TSUJIMOTO, H. KISHIMOTO, E. ISHIMURA, T. TABATA, and Y. NISHIZAWA Diabetes Mellitus, Aortic Stiffness, and Cardiovascular Mortality in End-Stage Renal Disease J. Am. Soc. Nephrol., October 1, 2001; 12(10): 2117 - 2124. [Abstract] [Full Text] [PDF]
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R. G. Asmar, G. M. London, M. E. O'Rourke, and M. E. Safar Improvement in Blood Pressure, Arterial Stiffness and Wave Reflections With a Very-Low-Dose Perindopril/Indapamide Combination in Hypertensive Patient: A Comparison With Atenolol Hypertension, October 1, 2001; 38(4): 922 - 926. [Abstract] [Full Text] [PDF]
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J. Blacher, A. P. Guerin, B. Pannier, S. J. Marchais, and G. M. London Arterial Calcifications, Arterial Stiffness, and Cardiovascular Risk in End-Stage Renal Disease Hypertension, October 1, 2001; 38(4): 938 - 942. [Abstract] [Full Text] [PDF]
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