1. Multiphasic effects of blood pressure on survival in hemodialysis patients
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Thierry Hannedouche, Hubert Roth, Thierry Krummel, Gérard M. London, Guillaume Jean, Jean-Louis Bouchet, Tilman B. Drüeke, Denis Fouque, Lahcene Attroun, Raymond Azar, Pierre Bories, Agnès Caillette-Beaudouin, Bernard Canaud, Gabriel Choukroun, Vincent Esnault, Mohamed Hammadi, Patrick Henri, Philippe Honoré, Belkacem Issad, Dominique Joly, Eric Laruelle, Gildas Le Mao, Sylvain Marchais, Benoît Vendrely, Philippe Zaoui, Larbi Aazib, Abdelhamid Abbassi, Elias Abdullah, Habib Abou-Bekr, Carine Achard-Hottelart, Geneviève Achin, Salima Ahriz-Saksi, Mahen Albadawy, Catherine Albert, Samir Albitar, Farideh Alenabi, Mahmoud Allouache, Amar Amaouche, Brahim Amara, Mounia Ammor, Kim Seng Ang, Ubald Assogba, Lynda Azzouz, Chérif Badid, Juliette Baleynaud, Evelyne Bargas, Emmanuel Baron, François Basse, Jean-Marie Batho, Marc Bauwens, Dorothée Bazin, Abdelmajid Ben Aicha, Seddik Benarbia, Larbi Bencheikh, Jean-Christophe Bendini, Djeleddine Benyakoub, Dominique Bergua, Catherine Bessin, Luc Billaux, Stéphane Billion, Haïat Bittar, Jean-Paul Bocquet, Hervé Bonarek, Claude Bonniol, Jean-Sébastien Borde, Samir Boubenider, Rémi Boudet, Waël Boudi, Loreley Boudier, Djema Bouguern, M Boukelmoune, Fatha Zohra Boukhalfa, Henri Boulanger, Philippe Bouvier, Mouloud Bouzernidj, Mohamed Brahim Bounab, José Brasseur, Laura Braun, Marie Briet, Doan Bui-Quang, Sebastien Canet, Eric Canivet, Jorge Cardozo, Carlos Cardozo, Baher Chaghouri, Mokhtar Chawki, Charles Chazot, Philippe Choulet, Pierre Clavel, Jean-Philippe Coindre, Olivier Coldefy, M.A. Colomina, François Combarnous, Christian Dabot, Djamal Dahmane, Ahmed Dahmani, Daniel Daubresse, Jean-François De Fremont, Valérie De Precigout, Françoise Dehais, M. Dehina, Caroline Delclaux, Yashou Delmas, Coralia Denicola, Jean-Philippe Devaux, Raji Diab, Zineddine Diddaoui, null Didelot, Yves Dimitrov, Assia Djema, Patrick Donnadieu, Valérie Drouillat, Olivier Drouineau, Geneviève Dumont, Philippe Dupuy, Pierre-Yves Durand, Stéphane Edet, Hamid El Ali, Khuzama El Nasser, Christian Emond, Baya Fadel, Mohamed Fakir, Jean-Paul Faucon, André Faure, Assia Ferhat-Carre, Hafedh Fessi, Rocsana Fickl, Mahammed Fodil-Cherif, Jacques Fourcade, Philippe Fournier, Rabah Fraoui, Olivier Fritz, Elke Gaboriau, Alexandre Ganea, Roula Galland, Jacqes Gaultier, Eric Gauthier, Sylvie Geffroy Guiberteau, Sandrine Genestier, Patrick Giraud, Françoise Glowacki, Christophe Goupy, Pierre Grimal, Mounir Guergour, Jean Gugliotta, Marie-Paule Guillodo, Marie-Claude Guimont, Toufic Hachache, Sabria Hacini, Imad Haddad, Mohamed Hadj-Abdelkader, Pascale Halin, Patrick Hallonet, Nasser Hamdini, Didier Hamel, Françoise Heibel, Alain Hermelin, Alim Heyani, Philippe Hiernaux, Maxime Hoffmann, Valérie Hugot, Richard Ibos, Dominque Jacq, Jean-Paul Jaulin, Philippe Jousset, Benoît Jonon, Véronique Joyeux, Laurent Juillard, Amer Kamal, Mimi Kareche Chibout, Rateb Khayat, Franklin Khazine, Karim Khellaf, Arnaud Klisnick, Yannick Knefati, A. Kolko-Labadens, Amir Kolta, Niloufar Kossari, Olivier Kourilsky, Nicolas Krayem, Marc Kribs, François Kuentz, Kristian Kunz, Christian Lamotte, Jean-Marc Lanau, Isabelle Landru, Achour Laradi, Nicole Larroumet, Olivier Lavelle, Frank Le Roy, Alejandra Lenz, Denis Lerda, Fanny Leroy, Marc Leteif, Martial Levannier, Thierry Lobbedez, Hassan Lockmane, Nathalie Longlune, Christie Lorriaux Mortuaire, Alain Lyon, Ghassan Maakaroun, Mehadji Maaz, Eric Magnant, Ghandour Majdalani, Jean-Luc Mahe, Edward Maksour, Stéphane Martin, Catherine Martinat-Calvo, Valérie Masson, Delia May, Claire Maynard, Brice Mayor, Omar Mazouz, Hocine Mehama, Dominique Mercier, Gilles Messier, Robert Milongo, Nicole Monnier, Karine Moreau, Xavier Moreau-Gaudry, Bertrand Morel, Luc Moulonguet Doleris, Alexandre Mouneimne, Catherine Mourey-Epron, Françoise Moussion, Blanca Muniz, J. Mustel, Rachida Nebbad, Fazia Nemmar, Sylvie Neuville, Tien Nguyen-Quang, Patrice Nolen, Michel Normand, Emerson N’Sembani, Jacques Ollier, Jean-Paul Ortiz, Messaoud Ouziala, Bernard Painchart, Pedro Palacin, Josette Pengloan, Franck Perrin, Bruno Perrone, Philippe Petitjean, Dominique Petregne, Jean-Baptiste Philit, Vincent Planquois, Marc Pocheville, Jacky Potier, Jean-Michel Poux, Olivier Puyoo, Catherine Quere-Maurouard, Ahmed Rachi, Anderson Ratsimbazafy, Matthieu Reberolle, Henri Renaud, Bernard Richalet, Sarah Richter, Philippe Rieu, Michel Rince, Odile Rivault, Alain Robert, Jacques Rottembourg, Philippe Rousseau, Sophie Rubens Duval, Christa Roubicek, Piotr Seniuta, Pascal Seris, Irina Shahapuni, Reda Sharobeem, Milad Shenouda, Hélène Sichez Com, Danlèle Simonin, Nadia Soltani, Marc Souid, Hadia Sow, Jean-Christophe Szelag, Catherine Taddei, Zafer Takla, Dominque Teboulle, Jean-Claude Terrat, Patrick Thomas, Adam Tifoura, Jacques Toulon, Dominique Touzard, Pablo Urena Torres, Hans Van der Pijl, Thierry Vanel, Carlos Vela, Isabelle Vernier, Cathy Verove, François Pascal Wambergue, Bassem Wehbe, Maeva Wong-Fat, Fatima Yazbeck, Djamal Yousfi, Maan Youssef, Abdelaziz Ziane, Service de néphrologie et hémodialyse [CHU de Strasbourg], CHU Strasbourg, Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-CHU Saint-Etienne-Hospices Civils de Lyon (HCL)-CHU Grenoble, Laboratory of Fundamental and Applied Bioenergetics = Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre Hospitalier Manhès, Centre de Rein Artificiel, Centre de traitement des maladies rénales, CTMR Saint-Augustin, Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Centre Européen de Nutrition pour la Santé, Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RH), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-CHU Saint-Etienne-Hospices Civils de Lyon (HCL)-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF), Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université Grenoble Alpes (UGA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)
- Subjects
Male ,medicine.medical_specialty ,hypertension ,Systole ,medicine.medical_treatment ,Population ,030232 urology & nephrology ,Diastole ,Blood Pressure ,030204 cardiovascular system & hematology ,[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,Prehypertension ,03 medical and health sciences ,0302 clinical medicine ,cardiovascular disease ,Renal Dialysis ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Prospective Studies ,Renal Insufficiency, Chronic ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,hemodialysis ,business.industry ,Hazard ratio ,Blood Pressure Determination ,Middle Aged ,3. Good health ,Pulse pressure ,Blood pressure ,Nephrology ,Cardiovascular Diseases ,Aortic pressure ,Cardiology ,Female ,Hemodialysis ,France ,business ,Follow-Up Studies - Abstract
International audience; Dialysis patients exhibit an inverse, L- or U-shaped association between blood pressure and mortality risk, in contrast to the linear association in the general population. We prospectively studied 9333 hemodialysis patients in France, aiming to analyze associations between predialysis systolic, diastolic, and pulse pressure with all-cause mortality, cardiovascular mortality, and nonfatal cardiovascular endpoints for a median follow-up of 548 days. Blood pressure components were tested against outcomes in time-varying covariate linear and fractional polynomial Cox models. Changes throughout follow-up were analyzed with a joint model including both the time-varying covariate of sequential blood pressure and its slope over time. A U-shaped association of systolic blood pressure was found with all-cause mortality and of both systolic and diastolic blood pressure with cardiovascular mortality. There was an L-shaped association of diastolic blood pressure with all-cause mortality. The lowest hazard ratio of all-cause mortality was observed for a systolic blood pressure of 165 mm Hg, and of cardiovascular mortality for systolic/diastolic pressures of 157/90 mm Hg, substantially higher than currently recommended values for the general population. The 95% lower confidence interval was approximately 135/70 mm Hg. We found no significant correlation for either systolic, diastolic, or pulse pressure with myocardial infarction or nontraumatic amputations, but there were significant positive associations between systolic and pulse pressure with stroke (per 10-mm Hg increase: hazard ratios 1.15, 95% confidence interval 1.07 and 1.23; and 1.20, 1.11 and 1.31, respectively). Thus, whereas high pre-dialysis blood pressure is associated with stroke risk, low pre-dialysis blood pressure may be both harmful and a proxy for comorbid conditions leading to premature death.
- Published
- 2015