Prevalence and control of hypertension in hemodialysis patients using ambulatory blood pressure in the area of Blida (Algeria)

Abstract

We aimed to evaluate the prevalence and control of hypertension using ABPM in a large hemodialysis population according to the latest definitions. A total of 178 hemodialysis patients underwent 24 hour ABPM during a regular hemodialysis session and pre-hemodialysis interval (PHD). HT was defined as pre-hemodialysis BP > = 140/90 mmHg or use of antihypertensive (ATH) drugs and ambulatory BP > = 130/80 mmHg or use of ATH drugs. The control phenotypes of hypertension were defined as follows: – concordant control (PHD BP < 140/90 mmHg and ABPM < 130/80 mmHg); – concomitant lack of control (PHD BP > = 140/90 mmHg and ABPM > = 130/80 mmHg); – “white coat” phenomenon (PHD BP > = 140/90 mmHg and ABPM < 130/80 mmHg); – masked hypertension (PHD BP < 140/90 mmHg and ABPM > = 130/80 mmHg). Mean BP values were: 141.7 ± 19 and 79.8 ± 11 mmHg. There was higher prevalence of uncontrolled systolic pressure and diastolic pressure rate in men ( P < 0.001). In PHD, the prevalence of HT was 93.1%. According to the ABPM and during the haemodialysis period, the prevalence was 84.6%. The proportion of hypertensive patients receiving treatment was 80.4%. With the use of BP in PHD and ABPM, 11.1% of hypertensive patients had concomitant control of BP, 63.2% of patients had no control of BP, 15.5% had a white coat phenomenon and 10.2% had masked HT. In multivariate analysis, only the use of antihypertensive drugs was independently associated with an increased likelihood of no control. A significant relationship between uncontrolled BP and diabetic nephropathy was found ( P = 0.01). Patients with uncontrolled BP most often used a calcium antagonist alone (87% vs. 48%). There was a significant difference in the presence of diabetes and cardiovascular disease between studied groups ( P < 0.01). The prevalence of hypertension in hemodialysis patients is extremely high. BP control rates differ between ABPM and office BP. Poor BP control in men may result from lower compliance. Combined antihypertensive therapy may increase adherence to reduce cardiovascular risk.