Diurnal variation of blood pressure; reproducibility and association with left ventricular hypertrophy in hemodialysis patients

Blood Press Monit. 2005 Feb;10(1):25-32. doi: 10.1097/00126097-200502000-00006.


Objective: The objective of this paper is to describe the pattern of diurnal blood pressure (BP) change in hemodialysis patients, determine the association of the non-dipping pattern of diurnal BP with left ventricular mass index (LVMI), and to determine if the nocturnal profile of BP is reproducible when repeated over time.

Methods: In a cross-sectional study, ambulatory blood pressure monitoring (ABPM) was performed over a midweek 44-h period and echocardiography was performed on the interdialytic day. Patients with a night/day systolic and diastolic BP ratio on both days >0.9 were defined as non-dippers. Ambulatory blood pressure monitoring was repeated at 6 and 12 months follow-up.

Results: Of the 59 patients, 88% were African-American, and 48% were non-dippers. Mean LVMI was significantly higher in the non-dipper (68.3+/-25 g/height) compared to the dipper patients (55.6+/-16, P<0.05). Mean nocturnal systolic BP (r=0.35) and the night/day systolic BP ratio (r=0.39) had a higher correlation with M-mode LVMI than pre-dialysis (r=0.32). After adjustment for 44-h mean SBP, night/day systolic BP ratio remained independently associated with LVMI (beta coefficient 147.62, P=0.004). Of 12 patients who had a non-dipper profile at baseline, 11 (92%) demonstrated the same profile after 6 months and 1 year of follow-up.

Conclusion: Many hemodialysis patients demonstrate a non-dipper profile; the degree of decline in nocturnal BP is independently associated with LVMI even after adjustment for mean BP. Patients who are identified as non-dippers consistently reproduce the same profile over time.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Pressure / physiology*
  • Blood Pressure Monitoring, Ambulatory
  • Circadian Rhythm / physiology*
  • Cross-Sectional Studies
  • Electrocardiography
  • Female
  • Humans
  • Hypertension / complications
  • Hypertrophy, Left Ventricular / physiopathology*
  • Kidney Failure, Chronic / complications
  • Male
  • Middle Aged
  • Renal Dialysis
  • Reproducibility of Results