1. The associations of blood pressure parameters with all-cause and cardiovascular mortality in peritoneal dialysis patients: a cohort study in China
- Author
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Duo Lv, Haiyan Zheng, Xiaohui Zhang, Fei Han, Jianghua Chen, and Xishao Xie
- Subjects
China ,medicine.medical_specialty ,Mean arterial pressure ,Physiology ,medicine.medical_treatment ,Blood Pressure ,030204 cardiovascular system & hematology ,Peritoneal dialysis ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Risk factor ,Cardiovascular mortality ,business.industry ,Proportional hazards model ,Pulse pressure ,Blood pressure ,Cardiovascular Diseases ,Hypertension ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Peritoneal Dialysis ,Cohort study - Abstract
It remains controversial to claim blood pressure (BP) as a leading risk factor for high risk of death in peritoneal dialysis patients, and less is known about the relationship between BP and mortality in Chinese peritoneal dialysis patients.From Zhejiang Renal Data System in China, we collected data on patients treated and followed up at 98 peritoneal dialysis centres from 2008 to 2016. The associations of BP parameters [SBP, DBP, mean arterial pressure (MAP) and pulse pressure (PP)] with all-cause and cardiovascular mortality were examined. We fitted Cox models for mortality with penalized splines using nonparametric smoothers. Several sensitivity analyses were performed to confirm the robustness of our primary findings.A total of 7335 Chinese peritoneal dialysis patients were included. During a median follow-up of 35.8 months, 1281 (17.5%) patients died. SBP, DBP, MAP follow a U-shaped pattern of both all-cause and cardiovascular mortality. PP presents a reverse L-shaped association with all-cause mortality. Either a higher (SBP141, DBP85 or MAP102 mmHg) or lower (SBP119, DBP67 or MAP88 mmHg) BP tends to have a significantly higher all-cause and cardiovascular mortality risk. Higher PP (60 mmHg) is related to a higher risk of all-cause mortality, but not cardiovascular mortality. These associations remain the same in our competing risk analysis and subgroup analyses.These data indicate U-shaped associations of SBP, DBP and MAP with all-cause mortality and cardiovascular mortality, respectively, and a reverse L-shaped association of PP with all-cause mortality. Further studies are needed to reliably establish the optimal BP targets for better hypertension control in peritoneal dialysis patients.
- Published
- 2020