Abstract
Hypertension is common and contributes to adverse outcomes in patients undergoing dialysis. However, the proper blood pressure (BP) target remains controversial and several factors make this difficult. This study aimed to investigate the adequate BP target in patients undergoing prevalent dialysis. Data were retrieved from the Clinical Research Center for End-Stage Renal Disease (2009–2014). 2,299 patients undergoing dialysis were evaluated. Patients were assigned into eight groups according to predialysis systolic blood pressure (SBP). The primary outcome was all-cause mortality. During the median follow-up of 4.5 years, a U-shape relation between SBP and mortality was found. The risk of mortality was increased in the SBP <110 and ≥170 mmHg groups. In subgroup analysis, the risk of mortality was similarly shown U-shape with SBP in subjects with no comorbidities, and no use of antihypertensive agents. However, only lowest SBP was a risk factor for mortality in patients with older, having diabetes or coronary artery disease, whereas highest SBP was an only risk factor in younger patients. In respect of dialysis characteristics, patients undergoing hemodialysis showed U-shape between SBP and mortality, while patients undergoing peritoneal dialysis did not. Among hemodialysis patients, patients with shorter dialysis vintage and less interdialytic weight gain showed U-shape association between SBP and mortality. This study showed that the lowest or highest SBP group had higher risk of mortality. Nevertheless, the optimal target BP should be applied according to individual condition of each patient.
Highlights
Hypertension is a common clinical problem and contributes to a high risk for adverse clinical outcomes in patients undergoing dialysis[1]
Managing blood pressure (BP) in patients undergoing dialysis may be hindered by multiple factors, such as age, comorbidities including diabetes mellitus (DM) or coronary artery disease (CAD), use of antihypertensive agents (AHAs), and dialysis characters [dialysis type, dialysis vintage, and poor dry weight (DW) control]1,8
We found a U-shaped relation between predialysis systolic blood pressure (SBP) and all-cause mortality
Summary
Hypertension is a common clinical problem and contributes to a high risk for adverse clinical outcomes in patients undergoing dialysis[1]. It is well known that strict blood pressure (BP) control could reduce major cardiovascular events and all-cause mortality in the general population[2,3]. Managing BP in patients undergoing dialysis may be hindered by multiple factors, such as age, comorbidities including diabetes mellitus (DM) or coronary artery disease (CAD), use of antihypertensive agents (AHAs), and dialysis characters [dialysis type, dialysis vintage, and poor dry weight (DW) control]1,8. For patients undergoing dialysis, several studies showed that lower BP is more related to adverse outcomes, especially in those with old age, DM, or cardiovascular complications[6,8]. The objective of this study was to investigate the optimal BP target and the effect of confounding factors on the clinical outcomes in patients undergoing prevalent dialysis
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