Differences in ambulatory bp levels and intensity of antihypertensive treatment between men and women undergoing peritoneal dialysis

Objective: The aim of the present study was to compare the ambulatory blood pressure (BP) levels and intensity of antihypertensive treatment between men and women with end-stage kidney disease receiving long-term peritoneal dialysis (PD). Design and method: Following a case-control design, 48 male PD patients from Northern Greece were matched for age and history of heart failure with 48 female patients in a 1:1 ratio. All patients underwent 24-hour ambulatory BP monitoring with the oscillometric device Mobil-O-Graph (IEM, Stolberg, Germany). The BP-lowering medications actually taken by the patients were prospectively recorded. Results: Age, dialysis vintage and the burden of cardiovascular comorbidities did not differ between men and women. There were no significant sex differences in ambulatory systolic BP (24-hour period: 129.0±17.8 vs. 128.5±17.5 mmHg, P = 0.138; daytime: 129.6±17.5 vs. 129.7±17.4 mmHg, P = 0.991; nighttime: 127.0±19.8 vs. 125.9±18.8 mmHg, P = 0.776). However, the levels of ambulatory diastolic BP were consistently higher in men than in women over the entire 24-hour period (81.5±12.1 vs. 76.8±10.3 mmHg, P<0.05) as well as during daytime (82.5±11.8 vs. 78.1±10.4 mmHg, P<0.05) and during nighttime (78.8±13.9 vs. 73.8±11.1 mmHg, P<0.05). The proportion of patients with 24-hour ambulatory BP <130/80 mmHg was numerically lower in men than in women (35.4% vs. 43.8%), despite the greater intensity of antihypertensive treatment in men. As compared with women, men were receiving a higher average number of BP-lowering medications daily (2.4±1.1 vs. 1.8±1.1, P<0.05) and were being treated more commonly with beta-blockers (85.1% vs. 66.7%, P<0.05) and dihydropyridine calcium-channel-blockers (70.2% vs. 43.8%, P = 0.01). Conclusions: The present study shows that among patients undergoing PD, the ambulatory BP levels and intensity of antihypertensive treatment are higher in men than in women. Prospective observational studies are needed to explore whether these sex differences in the severity of hypertension contribute to a higher risk for adverse health outcomes in men receiving long-term PD.