To the Editor:
We read with interest the article entitled “Progression of Aortic Pulse Wave Velocity in Patients With Chronic Kidney Disease” by Tholen and colleagues1 in a recent issue of The Journal of Clinical Hypertension. They evaluated the natural progression of arterial stiffness (AS) in patients with chronic kidney disease (CKD). Age, systolic blood pressure (BP), and diabetes were associated with accelerated progression. Interestingly, loss of renal function had no significant impact. We have some comments about this study.
The acute effects of hemodialysis on arterial stiffness parameters are still debatable.2, 3 Therefore, we wonder about the number of patients receiving hemodialysis in the present study. Indeed, in hemodialyzed patients, arterial stiffness is associated with calcification and progressed with the progression of atherosclerosis.4 Although it has not been replicated, several studies have shown an association between AS and renal function in patients with CKD.5 In the study population, baseline aortic pulse wave velocity (PWV) levels are significantly different in the three groups. Also, this study includes patients at very high risk with a small cohort and results cannot be extrapolated to other clinical situations. β‐Blockers can limit the destiffening of the arterial wall or increase its stiffness.6 Tholen and associates1 did not give any information about drug usage other than statins and renin‐angiotensin‐aldosterone‐system blockers. Aortic systolic BP increases with age and after 50 years of age, PWV increases and leads to augmentation of central systolic BP.7 Also, it can be influenced by diurnal variability in BP.8 Should it be expected to draw such a conclusion from only two measurements (baseline and after 12 months) as the authors suggested?
Finally, long‐term arterial remodeling, which may need several months to develop, contributes to the normalization of AS beyond BP‐lowering.9 Therefore, we question the statement that highlights 1 year as a short time interval in the discussion section.
Disclosure
None.
References
- 1. Tholen S, Klofat K, Pan CR, et al. Progression of aortic pulse wave velocity in patients with chronic kidney disease. J Clin Hypertens (Greenwich). 2013;15:833–838. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Di Iorio B, Nazzaro P, Cucciniello E, Bellizzi V. Influence of haemodialysis on variability of pulse wave velocity in chronic haemodialysis patients. Nephrol Dial Transplant. 2010;25:1579–1583. [DOI] [PubMed] [Google Scholar]
- 3. Georgianos PI, Sarafidis PA, Malindretos P, et al. Hemodialysis reduces augmentation index but not aortic or brachial pulse wave velocity in dialysis‐requiring patients. Am J Nephrol. 2011;34:407–414. [DOI] [PubMed] [Google Scholar]
- 4. Raggi P, Bellasi A, Ferramosca E, et al. Association of pulse wave velocity with vascular and valvular calcification in hemodialysis patients. Kidney Int. 2007;71:802–807. [DOI] [PubMed] [Google Scholar]
- 5. Ford ML, Tomlinson LA, Chapman TP, et al. Aortic stiffness is independently associated with rate of renal function decline in chronic kidney disease stages 3 and 4. Hypertension. 2010;55:1110–1115. [DOI] [PubMed] [Google Scholar]
- 6. Boutouyrie P, Lacolley P, Briet M, et al. Pharmacological modulation of arterial stiffness. Drugs. 2011;71:1689–1701. [DOI] [PubMed] [Google Scholar]
- 7. McEniery CM, Yasmin, Hall IR, et al. Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo‐Cardiff Collaborative Trial (ACCT). J Am Coll Cardiol. 2005;46:1753–1760. Epub 2005 Oct 10. [DOI] [PubMed] [Google Scholar]
- 8. Jerrard‐Dunne P, Mahmud A, Feely J. Circadian blood pressure variation: relationship between dipper status and measures of arterial stiffness. J Hypertens. 2007;25:1233–1239. [DOI] [PubMed] [Google Scholar]
- 9. Ong KT, Delerme S, Pannier B, et al. Aortic stiffness is reduced beyond blood pressure lowering by short‐term and long‐term antihypertensive treatment: a meta‐analysis of individual data in 294 patients. J Hypertens. 2011;29:1034–1042. [DOI] [PubMed] [Google Scholar]