Abstract: 【Abstract】Objective To investigate the effect of blood pressure variability (BPV) on cardiovascular events in end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD) and complicated with hypertension. Methods A total of 89 ESRD patients treated with MHD in our hospital from January 2017 to January 2018 were enrolled as the MHD group, and 100 healthy volunteers for physical examination in our hospital during the same period were recruited as the normal control group. The two BPV parameters, standard deviation of 24h mean systolic blood pressure (24hSBP- SD) and 24h mean diastolic blood pressure
(24hDBP-SD), were examined and compared between the two groups. According to the presence or absence of cardiovascular events during the follow-up period, the MHD patients were further divided into cardiovascular event subgroup (n=32) and non-cardiovascular event subgroup (n=57). Clinical data were analyzed by univariate and multivariate regression methods to evaluate the influencing factors for cardiovascular events in MHD patients. Results The 24hSBP- SD and 24hDBP- SD were 19.341 ± 2.765 mmHg and 10.102 ±1.758mmHg respectively in the MHD group, significantly higher than 11.852 ± 1.927mmHg and 6.824 ±
0.892 mmHg respectively in the normal control group (t=21.844 and 16.401, P＜0.001). Age, 24hSBP-SD, 24HDBP-SD and Hb were 67.571±8.542 years, 22.435±3.094mmHg, 12.042±1.857mmHg and 107.341±13.284g/L respectively in the cardiovascular event subgroup, and were 59.125±7.432 years, 18.017±2.385 mmHg, 8.765±0.929mmHg and 115.092±14.745g/L respectively in the non- cardiovascular event subgroup (t=4.391、7.537、11.179、2.464，P=0.008、＜0.001、＜0.001、0.016). Logistic regression analysis found that older age, higher 24HHBP-SD and 24HDBP-SD were the risk factors for cardiovascular events in MHD patients, while higher Hb level was the protective factor for cardiovascular events (OR=1.943, 2.509, 2.741 and 0.564
respectively; P=0.012, 0.007, 0.000 and 0.018 respectively). Receiver operating characteristic (ROC) curve showed that the sensitivity and specificity were 84.21% and 59.38% respectively when the cut- off value of 24h SBP-SD was set at 20.73mmHg; the sensitivity and specificity were 71.93% and 71.88% respectively, when the cut-off value of 24hDBP-SD was set at 10.59 mmHg. Conclusion BPV was increased in end-stage renal disease patients on MHD and complicated with hypertension. Higher BPV was the risk factor for cardiovascular events. BPV parameters measured earlier may be useful for the prediction of cardiovascular events.

Key words: Hypertension, Maintenance hemodialysis, Blood pressure variability, Cardiovascular event