Association of blood pressure with all‐cause mortality and stroke in Japanese hemodialysis patients: The Japan dialysis outcomes and practice pattern study

Abstract

The association of low blood pressure (BP) with high mortality is a characteristic for hemodialysis patients. This analysis clarifies the association of BP with mortality and stroke in Japanese hemodialysis (HD) patients and examines the association separately for patients with and without antihypertensive medication (BP meds). We analyzed 9134 patients from Japan in phases 1-4 (1999-2011) of the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective cohort study of in-center HD patients. The association of patient systolic (SBP) and diastolic (DBP) blood pressure with all-cause and cause-specific mortality was assessed using adjusted Cox regression. A U-shaped association between BP and all-cause mortality was observed, with lowest mortality for baseline SBP 140-159 mmHg and DBP 65-74 mmHg. Both SBP and DBP were positively and monotonically associated with stroke-related death: hazard ratio (95% confidence interval) was 1.24 (1.01-1.53) per 20 mmHg higher SBP and 1.23 (1.05-1.44) per 10 mmHg higher DBP. No evidence of interaction was found between SBP and use of BP meds regarding all-cause mortality (P for interaction = 0.97); the association between SBP and stroke-related death was slightly stronger among patients not on BP meds than patients on BP meds (P for interaction = 0.09). In Japanese HD patients, both low and high BP are associated with all-cause mortality. This analysis also documents a positive and monotonic association of BP with stroke-related deaths. Although our analysis indicates that the prescription of BP meds to hypertensive patients might protect against stroke-related death, additional study is warranted.

Circulating TNF Receptors 1 and 2 Predict Mortality in Patients with End-stage Renal Disease Undergoing Dialysis

“…Inaba et al 2. reported that both low and high BP are associated with all-cause mortality in 9134 Japanese haemodialysis patients of the Dialysis Outcomes and Practice Patterns Study cohort.…”

“…However, the risk factors contributing to atherosclerosis, other than cholesterol, blood pressure, or smoking, remain to be clarified123. Recently, chronic low-grade inflammation, such as that due to tumor necrosis factor (TNF) system activity, has been shown to play an important role in the progression of not only kidney disease but also atherosclerotic disease456.…”

Predialysis hypotension is not a predictor for mortality in long-term hemodialysis patients: insight from a single-center observational study

“…This might be the reason that our predialysis hypotension patients did not have higher mortality rate than patients without predialysis hypotension. Inaba et al16 also showed that in Japanese HD patients, both low and high BP were associated with all-cause mortality. Zager et al17 demonstrated that predialysis, neither systolic nor diastolic hypertension was associated with an increase in CV mortality.…”

Strategies for the Super-Aged Dialysis Population: Survival Benefits or Alternative Goals?

“…Figure 6 shows declining RRs of mortalities in all age groups over a recent 20-year period. In fact, DOPPS (1999-2011) found 9,134 Japanese patients had a positive monotonic association of BP with stroke-related death [38]. Medication for BP control might protect against cerebrovascular disease, especially intracerebral hemorrhage.…”