ABSTRACT
BACKGROUND: Inverse associations between risk factors and mortality have been reported in epidemiological studies of patients on maintenance hemodialysis (MHD). OBJECTIVE: The aim of this prospective study was to estimate the effect of the dual variable pulse pressure (PP) - body mass index (BMI) on cardiovascular (CV) events and death in type 2 diabetic (T2D) subjects on MHD in a Caribbean population. METHODS: Eighty Afro-Caribbean T2D patients on MHD were studied prospectively from 2003 to 2006. Proportional-hazard modeling was used. RESULTS: Of all, 23.8% had a high PP (PP > or = 75th percentile), 76.3% had BMI < 30 Kg/m(2), 21.3% had the dual factor high PP - absence of obesity. During the study period, 23 patients died and 13 CV events occurred. In the presence of the dual variable and after adjustment for age, gender, duration of MHD, and pre-existing CV complications, the adjusted hazard ratio (HR) (95% CI) of CV events and death were respectively 2.7 (0.8-8.3); P = 0.09 and 2.4 (1.1-5.9); P = 0.04. CONCLUSIONS: The dual factor, high PP - absence of obesity, is a prognosis factor of outcome. In type 2 diabetics on MHD, a specific management strategy should be proposed in nonobese subjects with wide pulse pressure in order to decrease or prevent the incidence of fatal and nonfatal events.
Subject(s)
Blood Pressure , Body Mass Index , Cardiovascular Diseases/etiology , Diabetes Mellitus, Type 2/physiopathology , Diabetic Nephropathies/therapy , Renal Dialysis , Aged , Cardiovascular Diseases/mortality , Cardiovascular Diseases/physiopathology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/mortality , Diabetic Nephropathies/etiology , Diabetic Nephropathies/mortality , Diabetic Nephropathies/physiopathology , Female , Humans , Longitudinal Studies , Male , Middle Aged , Proportional Hazards Models , Prospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , West Indies/epidemiologyABSTRACT
BACKGROUND: The aims of this study were to examine systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) in patients with type 2 diabetes undergoing hemodialysis (HD), and to assess the relationships between these parameters and cardiovascular (CV) events such as coronary heart disease and congestive cardiac failure. METHODS: A total of 80 Afro-Caribbean type 2 diabetic patients undergoing hemodialysis in three centers in Guadeloupe, French West Indies, were included in this cross-sectional study. Pre- and postdialysis BP were recorded. Logistic regression methods and areas under the receiver operating characteristic curves were used. RESULTS: The mean age (+/- standard deviation) was 62.2 years (+/-10.2 years). A total of 24 subjects (30%) had one or more CV events. Sixteen (20%) had coronary disease, 15 (18.8%) cardiac failure, and seven (8.8%) had both. The medians [interquartile ranges] for predialysis PP was higher in patients with CV comorbidity than in patients without a history of CV at 84.5 mm Hg [74.5 to 92.3]v 69.5 mm Hg [61.0 to 79.5], P = .003. Areas under the ROC curves (95% confidence intervals) predialysis were significant only for SBP and PP at 0.70 (0.58 to 0.82) v 0.71 (0.59 to 0.83) without statistical differences. After adjustment for gender, age, body mass index, antihypertensive use, time on hemodialysis (>or=2 years), and hemoglobin rate, the odds ratio was significant only predialysis, and a higher odds ratio was found for PP at 2.25 (1.22 to 4.18), P = .01, than for SBP 1.97 (1.12 to 3.49), P = .02. CONCLUSIONS: Our results suggest that the strongest association of PP with CV morbidities should be considered in therapeutic strategies. These results show the necessity of targeting antihypertensive treatment to patients' predialysis blood pressure values.
