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Hypertension. 2018 Feb;71(2):289-296. doi: 10.1161/HYPERTENSIONAHA.117.10274. Epub 2017 Dec 18.

Geographical Variations in Blood Pressure Level and Seasonality in Hemodialysis Patients.

Author information

1
From RD-Néphrologie, Montpellier, France (F.D., N.G., À.A.); BC2M (EA7288) (F.D., N.G., B.J., À.A.) and PhyMedExp, INSERM U1046, CNRS UMR 9214 (B.J.), Université de Montpellier, France; ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, Universiteit van Amsterdam, The Netherlands (A.K., Z.A.M., K.J.J.); Néphrologie Dialyse Saint Guilhem, Sète, France (I.S., F.V., M.-F.S., À.A.); Arbor Research Collaborative for Health, Ann Arbor, MI (B.B., F.T.); Ambroise Paré University Hospital and Inserm U1018 Team 5 (CESP), Paris, France (Z.A.M.); Unité INSERM 1026, University of Bordeaux, France (C.C.); and Service de Néphrologie Transplantation Dialyse, CHU de Bordeaux, France (C.C.).
2
From RD-Néphrologie, Montpellier, France (F.D., N.G., À.A.); BC2M (EA7288) (F.D., N.G., B.J., À.A.) and PhyMedExp, INSERM U1046, CNRS UMR 9214 (B.J.), Université de Montpellier, France; ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, Universiteit van Amsterdam, The Netherlands (A.K., Z.A.M., K.J.J.); Néphrologie Dialyse Saint Guilhem, Sète, France (I.S., F.V., M.-F.S., À.A.); Arbor Research Collaborative for Health, Ann Arbor, MI (B.B., F.T.); Ambroise Paré University Hospital and Inserm U1018 Team 5 (CESP), Paris, France (Z.A.M.); Unité INSERM 1026, University of Bordeaux, France (C.C.); and Service de Néphrologie Transplantation Dialyse, CHU de Bordeaux, France (C.C.). argiles@rd-n.org.

Abstract

Seasons and climate influence the regulation of blood pressure (BP) in the general population and in hemodialysis patients. It is unknown whether this phenomenon varies across the world. Our objective was to estimate BP seasonality in hemodialysis patients from different geographical locations. Patients from 7 European countries (Spain, Italy, France, Belgium, Germany, United Kingdom, and Sweden) participating in the DOPPS (Dialysis Outcomes and Practice Patterns Study) on years 2005 to 2011 were studied. Factors influencing pre- and postdialysis systolic BP and diastolic BP levels were analyzed by mixed models. There were 9655 patients (median age, 68; 59% male) from 263 facilities, seen every 4 months during a median duration of 1.3 years. Pre- and postdialysis systolic BP increased by a mean estimate of 5.1 mm Hg (95% confidence interval [CI], 3.7-6.4 mm Hg) and 4.4 mm Hg (95% CI, 2.9-5.9 mm Hg) for each 10° increase in latitude (1111 km to the North). In the longitudinal analysis, predialysis systolic BP was lower in summer and higher in winter (difference, 1.7 mm Hg; 95% CI, 1.3-2.2 mm Hg), with greater differences in southern locations (Pinteraction=0.04). Predialysis systolic BP was inversely associated with outdoor temperature (-0.8 mm Hg/7.2°C; 95% CI, -1.0 to -0.5 mm Hg/7.2°C), with steeper slopes in southern locations (Pinteraction=0.005). Results were similar for predialysis diastolic BP. In conclusion, there is a geographical and seasonal gradient of BP in European hemodialysis patients. There is a need to consider these effects when evaluating and treating BP in this population and potentially in others.

KEYWORDS:

blood pressure; geography; longitudinal studies; renal dialysis; seasons; weather

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