I determinanti pressori dell'ipertrofia ventricolare sinistra negli emodializzati

Arterial hypertension is an established risk factor for left ventricular hypertrophy (LVH) in the uremic population. However, whether in these patients 24-h monitoring is a better predictor of LVH than clinic BP and routine predialysis measurements is still undefined. We studied this problem in 64 nondiabetic hemodialysis patients without heart failure. The echocardiographic study as well as the clinic and 24-h ambulatory BP measurements were performed during the day off-dialysis. Predialysis arterial pressure was calculated as the average value of the 12 routine recordings taken during the month preceding the study. In multivariate models incorporating other independent predictors of heart geometry (Sex, BMI, Hematocrit, Cholesterol) predialysis systolic, diastolic and pulse pressures were the only BP determinants of echocardiographic parameters. 24-h ABPM did add significant (but weak) information to the prediction of left ventricular internal dimension (LVEDD), i.e. increased by the 9% (P = 0.01) the variance already explained by pre-dialysis diastolic BP and other significant covariates. However, 24-h ABPM did not add any significant and independent explanatory information to the corresponding pre-dialysis measurements for the posterior wall and interventricular septum measurements (PWT, IVST, MWT, RWT) and for left ventricular mass (-0.6 to +3.9%, average +1.1%). In dialysis patients pre-dialysis BP is at least as strong a predictor of left ventricular mass as 24-h ambulatory monitoring. Thus the average of 12 routine pre-dialysis measurements may be used to predict heart geometry in dialysis patients without any loss of information in comparison to 24-h ambulatory monitoring.