Prevalence of Hypertension and Impact of Predialysis Systolic Blood Pressure on Cardiovascular Mortality in Chronic Hemodialysis Patients

Yun, Yeo Wook; Han, Sang Woong; Kim, Ho Jung

Abstract

BACKGROUND
Hypertension is very common in chronic hemodialysis patients. But impact of predialysis systolic blood pressure on cardiovascular mortality is not clear and it's investigation is not thoroughgoing enough in Korea. METHODS: We assessed the prevalence and control rate of hypertension in a cross sectional study of 81 clinically stable hemodialysis patients who had been treated with regular hemodialysis sessions in the Hanyang University Guri Hospital. To investigate the impact of predialysis systolic blood pressure on cardiovascular mortality, we retrospectively reviewed in May 2001 predialysis blood pressure and covariable factors of 115 hemodialysis patients who were monitored from the start of hemodialysis for more than 2 months between May 2001 and May 2004 in the Hanyang University Guri Hospital and local dialysis centers. Exclusion criteria were as follows: change to CAPD, transplantation, transfer to another dialysis center, non compliant, death due to accident and self withdrawal and hemodialysis for less than 2 months. RESULTS: The majority of hemodialysis patients (83%) take antihypertensive medications. Pre and post dialysis mean blood pressure was 153.2+/-14.5/86.9+/-4.7 mmHg, 145.5+/-17.1/84.2+/-5.2 mmHg respectively. Predialysis systolic blood pressure that was higher than 140 mmHg documented in 83% of patients. On the other side, predialysis diastolic blood pressure that was higher than 90 mmHg was only seen in 23 % of patients. Predialysis systolic hypertension was not associated with an increase in short term cardiovascular mortality. On the other hand, hypoalbuminemia and diabetes mellitus were associated with an increase in short term cardiovascular mortality. CONCLUSION: The present study suggests that control of hypertension, particularly systolic hypertension, in chronic hemodialysis patients, is insufficient, despite the use of antihypertensive drugs. The overall impact of predialysis systolic hypertension on cardiovascular mortality tends to be increased, but it was not associated with short term cardiovascular mortality.