Volume Reduction is More Important than Pressure Reduction to Regress Left Ventricular Hypertrophy in Hypertensive Hemodialysis Patients

Background: Hypertension is a major risk factor for left ventricular hypertrophy and cardiovascular disease in hemodialysis patients. Volume overload is the cause of hypertension in hemodialysis patient. Ultrafiltration can regress left ventricular hypertrophy and reduce cardiac failure e in hemodialysis patients. Method: We decreased the dry weight of seven hypertensive hemodialysis patients with excessive extracellular volume (ECV) by increasing ultrafiltration and followed up left ventricular mass index (LVMI) one year later. Result: After decreasing the dry weight of seven excessive ECV% patients, the ECV% decreased to normal subjects’ range in every patient. The ECV% had significantly decreased (27.39±2.12% v 23.74± 1.92%,p＜0.005), and LVMI had also substantially decreased (155± 19g/m2 v 115 ±34g/m2,p＜0.05). Table 1 showed the changes of ECV%, LVMI and blood pressure before and after decreasing dry weight in the seven patients. One patient’s blood pressure became normal and left ventricular hypertrophy subsided. The other six patients' blood pressure became easily controlled. The antihypertensive drugs or doses were reduced, but they still needed to take antihypertensive therapy. However, left ventricular hypertrophy subsided in three patients and still increased in the other three patients. From this study, all the seven patients' ECV% decreased and LVMI decreased. Three patients' LVMI became normal in spite of persisting hypertension. Table 1. The changes of ECV%, LVMI and blood Pressure Before and After Decreasing Dry Weight Abbreviations: F, female; M, male; B, before decreasing dry weight; A, after decreasing dry weight; N, blood pressure became normal; Y, blood pressure became easily controlled. Conclusion: the decreased in volume is more important that pressure reduction in order to decrease LVMI.

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