2/20/2023 0 Comments Narrow pulse pressure![]() ![]() The purpose of this review is to show the importance of pulse pressure (PP) as clinical marker of cardiovascular risk in patients with CKD. Oxidant stress and inflammation may be the primary mediators or the “missing link” that could explain the tremendous burden of CVD in CKD ( 2). Several nontraditional factors, such hyperhomocysteinemia, oxidant stress, dyslipidemia, and elevated inflammatory markers, are associated with atherosclerosis. Most of the traditional CVD risk factors, such as older age, diabetes, systolic hypertension, left ventricular hypertrophy, and low HDL cholesterol, are highly prevalent in CKD. ( 4) demonstrated that reduced estimated GFR <60 ml/min per 1.73 m 2 independently predicts the risk for death and cardiovascular events in individuals with or without known CVD. The task force recommended that patients with CKD be considered in the highest risk group. This report showed that there was a high prevalence of CVD in CKD and that mortality as a result of CVD was 10 to 30 times higher in dialysis patients than in the general population. ![]() In 1998, the National Kidney Foundation Task Force issued a report that emphasized the high risk for CVD in CKD ( 3). CVD in CKD is treatable and potentially preventable, and CKD seems to be a risk factor for CVD ( 2). However, cardiovascular disease (CVD) also frequently is associated with CKD, which is important because individuals with CKD are more likely to die of CVD than to develop ESRD ( 1). ESRD that requires treatment with dialysis or transplantation is the most visible outcome of CKD. There is a rising incidence and prevalence of ESRD, with poor outcome and high cost. The purpose of this review is to show the importance of PP on cardiovascular risk in patients with CKD, including kidney transplant recipients.Ĭhronic kidney disease (CKD) is a worldwide public health problem. Several studies have shown that PP is a reliable prognostic factor for mortality and CVD in patients who have CKD and are on hemodialysis and in renal transplant patients. The burden of hypertension is present at all stages of CKD. Most of the traditional CVD risk factors are highly prevalent in CKD, and several nontraditional factors also are associated with atherosclerosis in CKD. This holds true for all stages of kidney disease, including ESRD that requires renal replacement therapy. The progression of kidney disease and its associated cardiovascular complications are the major causes of morbidity and mortality. Chronic kidney disease (CKD) is a major public health problem. Increasingly, PP is recognized as an independent predictor of myocardial infarction, congestive heart failure, and cardiovascular death, even in hypertensive patients who undergo successful antihypertensive drug therapy, especially in older individuals. PP reflects stiffness of the large arteries and increases with age. Systolic BP seems to be a more important factor than diastolic BP on cardiovascular and all-cause mortality in older patients. Recently published prospective studies have focus on systolic and pulse pressure (PP). It was first described in 1935 by an American cardiothoracic surgeon Calude Beck (1894-1971).Epidemiologic studies have emphasized the close relationship between high BP and cardiovascular disease (CVD). ![]() Excess fluid around the heart deadens the cardiac sounds. Also, increased outside pressure reduces the end-systolic filling capacity of the atria, hence a rapid increase and higher pressure in atria leads to increased pressure in, and distension of, the jugular veins even when the patient is in an upright position. Based on Frank Starling's law, a decreased end-diastolic volume means weaker stroke volume and hence lower systolic blood pressure. The accumulation of fluid in the pericardial sac, particularly if it happens quickly, can result in marked increased pressure outside the heart this subsequently reduces the ability of the ventricles to accommodate enough blood volume at the end of diastole.
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