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Risk factors for hypertension in chronic hemodialysis patients: baseline data from the HEMO study
1Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1053, USA. mrocco@wfubmc.edu
Insights
Hypertension is common in hemodialysis patients, with diabetes and older age as key risk factors. Managing ultrafiltration volume is crucial for controlling blood pressure in this population.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Hypertension
Background:
- Hypertension is a prevalent comorbidity in patients undergoing chronic hemodialysis.
- Blood pressure management is critical for reducing cardiovascular risk in this population.
- The HEMO Study provided a valuable dataset for investigating hypertension risk factors.
Purpose of the Study:
- To identify risk factors associated with hypertension in chronic hemodialysis patients.
- To analyze the relationship between blood pressure and ultrafiltration volume.
- To inform strategies for improving hypertension management in hemodialysis.
Main Methods:
- Cross-sectional analysis of 1,238 chronic hemodialysis patients from the HEMO Study.
- Assessment of pre- and post-dialysis blood pressures (systolic and diastolic).
- Identification of risk factors including demographics, comorbidities, medications, and laboratory values.
Main Results:
- Over 70% of patients exhibited blood pressures above normotensive levels.
- Risk factors for elevated systolic blood pressure included diabetes, older age, more antihypertensive medications, lower hematocrit, and absence of arrhythmias.
- Ultrafiltration volume showed a nonlinear relationship with blood pressure, with extremes associated with elevated readings.
Conclusions:
- Hypertension is widespread among hemodialysis patients, influenced by factors like diabetes and age.
- Ultrafiltration volume management is critical, suggesting potential issues with interdialytic fluid intake or dry weight prescription.
- Optimizing fluid management and dry weight may reduce hypertension prevalence and severity.
Abstract:
A cross-sectional analysis was performed to determine risk factors associated with hypertension in 1,238 chronic hemodialysis patients upon enrollment into the HEMO Study. The mean pre- and post-dialysis systolic blood pressure were 152.4 +/- 25.0 (mean +/- SD) and 137.8 +/- 24.6 mm Hg, respectively. The mean pre- and post-dialysis diastolic blood pressures were 82.1 +/- 14.8 and 74.7 +/- 13.8 mm Hg, respectively. Less than 30% of the study cohort had blood pressures that were normotensive by JNC VI guidelines. Risk factors associated with higher pre- and post-dialysis systolic blood pressures included the presence of diabetes mellitus, older age, increased number of prescribed antihypertensive medications, lower hematocrit, and absence of arrhythmias. Variables associated with higher pre- and post-dialysis diastolic blood pressures included younger age, increased number of prescribed anti-hypertensive medications and absence of arrhythmias. There was also a nonlinear relationship between blood pressure and prescribed total ultrafiltration volume. A total ultrafiltration volume of >2.5 kg was associated with an elevation in pre-dialysis systolic and diastolic blood pressures. A total ultrafiltration volume of < or =2.5 kg was associated with an elevation in post-dialysis systolic and diastolic blood pressures. These data on ultrafiltration volume suggest that higher pre-dialysis blood pressures may be associated with excessive interdialytic weight gains due to patient noncompliance with fluid restriction and that higher post-dialysis blood pressures may be associated with a prescribed dry weight that is higher than the patient's true dry weight. Better management of these parameters may improve the prevalence and severity of hypertension in this population.