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Hypertension in the hemodialysis population: a survey of 649 patients
1Department of Medicine, University of Mississippi Medical Center, Jackson 39110, USA.
Insights
High blood pressure (hypertension) affects 72% of US hemodialysis patients, with no difference by race. Treatment with blood pressure medications showed limited effectiveness in controlling hypertension in this population.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Public Health
Background:
- Accurate data on blood pressure control in US hemodialysis patients is scarce.
- Hypertension is a common and serious comorbidity in patients with end-stage renal disease.
Purpose of the Study:
- To determine the prevalence and status of blood pressure control among hemodialysis patients in Mississippi.
- To identify factors influencing blood pressure levels and the effectiveness of antihypertensive treatments in this population.
Main Methods:
- A survey of 649 hemodialysis patients from 10 dialysis units in Mississippi.
- Blood pressure was defined as mean arterial pressure > or = 114 mm Hg prior to dialysis.
- Statistical analysis was performed to assess the influence of various factors on blood pressure.
Main Results:
- Hypertension prevalence was 72%, with no significant difference between black and white patients.
- Age was the only significant factor correlating with blood pressure; older patients had lower levels.
- Antihypertensive treatment showed limited effectiveness, with treated patients having only slightly lower blood pressure than untreated patients.
Conclusions:
- A high prevalence of hypertension exists among hemodialysis patients in Mississippi.
- Current antihypertensive treatment strategies appear to have limited impact on blood pressure control in this population.
- Further research is needed to optimize blood pressure management in hemodialysis patients.
Abstract:
Accurate information on prevalence and status of blood pressure control among US hemodialysis patients is lacking. We have surveyed the status of blood pressure control in 649 hemodialysis patients (89.8% black) from 10 dialysis units in Mississippi. Our results show a hypertension prevalence of 72% (hypertension defined as mean arterial pressure prior to dialysis session > or = 114 mm Hg). This mean arterial pressure did not differ among black patients compared with white patients (P = 0.51). The majority of hypertensive patients (80%) had elevation of both systolic and diastolic blood pressure. Isolated systolic hypertension was present in only 20% of hypertensive patients and was not different between black and white patients (P = 0.10). Three hundred eighty-one patients (58.7% of the total population and 81.5% of the hypertensive patients) were receiving antihypertensives. Age was the only significant factor that correlated with blood pressure: older patients (> 65 years) had lower blood pressure (P < 0.0001). Race, time on dialysis, etiology of end-stage renal disease, adequacy of dialysis, and several excess volume parameters had no influence on the blood pressure level. Treated hypertensive patients had a predialysis mean blood pressure only 3 mm Hg less than the untreated hypertensive patients. No differences were found among four classes of antihypertensives with regard to the degree of blood pressure control. Patients with hypertension requiring more than one antihypertensive did not achieve a lower blood pressure than the untreated patients. There was no correlation between use of antihypertensives and the magnitude of decrease in blood pressure after dialysis.(ABSTRACT TRUNCATED AT 250 WORDS)