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Titolo	Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overload
Autore	Peter Wabel, Ulrich Moissl, Paul Chamney, Tomas Jirka, Petr Machek, Pedro Ponce, Petr Taborsky, Ciro Tetta, Nestor Velasco, Jiri Vlasak, Wojciech Zaluska and Volker Wizemann
Referenza	Nephrol Dial Transplant 2008: doi: 10.1093/ndt/gfn228
Contenuto	Background. Hypertension and fluid overload (FO) are well-recognized problems in the chronic kidney disease (CKD) population. While the prevalence of hypertension is well documented, little is known about the severity of FO in this population. Methods. A new bioimpedance spectroscopy device (BCM?Body Composition Monitor) was selected that allows quantitative determination of the deviation in hydration status from normal ranges (_HS). Pre-dialysis systolic blood pressure (BPsys) and _HS was analysed in 500 haemodialysis patients from eight dialysis centres.Agraphical tool (HRP?hydration reference plot) was devised allowing _HS to be combined with measurements of BPsys enabling comparison with a matched healthy population (n = 1244). Results. Nineteen percent of patients (n=95)were found to have normal BPsys and_HS in the normal range. Approximately one-third of patients (n = 133) exhibited reasonable control of BPsys and fluids (BPsys <150 mmHg and _HS <2.5 L). In only 15% of patients (n = 74) was hypertension observed (BPsys >150 mmHg) with a concomitant _HS >2.5 L (possible volume-dependent hypertension). In contrast, 13% of patients (n=69) were hypertensive with_HS <1.1 L (possible essential hypertension). In 10% of patients (n = 52), BPsys <140 mmHg was recorded despite _HS exceeding 2.5 L. Conclusion. Our study illustrated the wide variability in BPsys regardless of the degree of _HS. The HRP provides an invaluable tool for classifying patients in terms of BPsys and_HS and the proximity of these parameters to reference ranges. This represents an important step towards more objective choice of strategies for the optimal treatment of hypertension and FO. Further studies are required to assess the prognostic and therapeutic role of the HRP.
Data	14.05.2008

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