Blood pressure during the interdialytic period in haemodialysis patients: estimation of representative blood pressure values

Jp, Kooman; Gladziwa, U.; Böcker, George; Wijnen, J. A. G.; Bortel, L. Van; Luik, A. J.; Leeuw, Peter W. de; Hooff, J. P. van; Leunissen, Karel M.L.

doi:10.1093/ndt/7.9.917

Cited by 93 publications

(51 citation statements)

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“…However, postdialysis BP may correlate best with mean interdialytic BP assessed by ambulatory BP monitoring (32). In our study, HR for postdialysis SBP above the referent category tended to be higher than the corresponding predialysis values, suggesting that hypertension postdialysis may be a stronger predictor of mortality compared with predialysis hypertension.…”

Section: Discussioncontrasting

confidence: 45%

Changing Relationship of Blood Pressure with Mortality over Time among Hemodialysis Patients

Stidley

Hunt

Tentori

et al. 2006

Journal of the American Society of Nephrology

129

106

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High BP is a major risk factor for atherosclerotic cardiovascular disease mortality in the general population. Surprising, studies that have been conducted among hemodialysis (HD) patients have yielded conflicting data on the relationship between BP and mortality. This study explores two hypotheses among HD patients: (1) The relationship between BP and mortality changes over time, and (2) mild to moderate hypertension is well tolerated. Incident HD patients who were treated at Dialysis Clinic Inc. facilities between 1993 and 2003 were studied. Primary end points were atherosclerotic cardiovascular disease and all-cause mortality. The relationship between BP and mortality was analyzed in two sets of Cox proportional hazards models. Model-B explored the relationship between baseline BP and mortality in sequential time periods. Model-TV assessed the relationship between BP, treated as time-varying, and mortality. The study sample (n ‫؍‬ 16,959) was similar in characteristics to the United States Renal Data Systems population, although black patients were slightly overrepresented. Model-B demonstrated that the relationship between baseline BP and mortality changes over time. Low systolic BP (<120 mmHg) was associated with increased mortality in years 1 and 2. High systolic BP (>150 mmHg) was associated with increased mortality among patients who survived >3 yr. Low pulse pressure was associated with increased mortality. Model-TV demonstrated that mild to moderate systolic hypertension may be relatively well tolerated. In conclusion, the relationship between baseline BP and mortality changes over time. Mild to moderate systolic hypertension was associated with only modest increases in mortality.

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Section: Discussioncontrasting

confidence: 45%

Changing Relationship of Blood Pressure with Mortality over Time among Hemodialysis Patients

Stidley

Hunt

Tentori

et al. 2006

Journal of the American Society of Nephrology

129

106

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“…However, as many as 78% achieved the diastolic target of 90 mm Hg. This is in keeping with other reports of poor BP control on dialysis [6, 7, 8, 9, 10, 11, 12]. There is thus room for improvement, especially since relatively few antihypertensive drugs were prescribed in our patients (1.7 ± 0.8) and in view of the fact that to achieve optimum reduction in cardiovascular risk, even lower target BPs may be advisable [19, 20].…”

Section: Discussionsupporting

confidence: 89%

“…For example, in the UK, only 41% of the haemodialysis patients under the age of 60 years from units contributing to the Renal Registry achieved the recommended standard of <140/90 mm Hg, and 60% of those over 60 achieved the standard of <160/90 mm Hg; the corresponding figures for continuous ambulatory peritoneal dialysis (CAPD) were 51 and 69% [5]. This is in keeping with other published reports of BP control in patients on renal replacement treatment [6, 7, 8, 9, 10, 11, 12]. …”

Section: Introductionsupporting

confidence: 79%

Blood Pressure Control before and after Starting Dialysis

Dasgupta¹,

Burden²

2005

Nephron Clin Pract

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Background/Aim: We have previously reported a study on the adequacy of management of hypertension in patients developing end-stage renal failure (ESRF) over a period of 3 years from a single health district in the UK (n = 107). There were significant shortcomings in all aspects of management of hypertension including blood pressure (BP) control. Methods: In this report, we have compared BP control in the same cohort of patients before and after starting renal replacement therapy (RRT). Results: BP control improved significantly after the patients were established on dialysis (mean 158/ 87 mm Hg pre-RRT vs. 152/82 mm Hg post-RRT; p < 0.0001), and fewer antihypertensive agents were prescribed to control BP (mean 2.45 vs. 1.74) in this period (p < 0.0001). Moreover, patients on continuous ambulatory peritoneal dialysis (n = 50) had a better systolic BP control compared with the haemodialysis patients (n = 57; p = 0.03). Conclusions: This study shows significant improvement in BP control in a cohort of patients with ESRF following the start of dialysis.

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“…One study demonstrated that post-HD systolic BP correlated better with interdialytic ABP than pre-HD systolic BP did in 22 subjects (16). An important limitation of that study is the low prevalence of HTN (mean systolic ABP was 129), thus the findings cannot be generalized to interpreting HD-unit BP in the context of HTN management.…”

Section: Discussionmentioning

confidence: 85%

Intradialytic Hypertension and the Association with Interdialytic Ambulatory Blood Pressure

Buren

Kim

Toto

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Increasing BP during maintenance hemodialysis or intradialytic hypertension is associated with increased morbidity and mortality. In hemodialysis patients, ambulatory BP measurements predict adverse cardiovascular outcomes better than in-center measurements. We hypothesized that patients with intradialytic hypertension have higher interdialytic ambulatory systolic BP than those without intradialytic hypertension. Design, setting, participants, & measurementsWe performed a case-control study in adult hemodialysis patients. Cases consisted of subjects with intradialytic-hypertension (systolic BP increase Ն10 mmHg from pre-to posthemodialysis in at least four of six treatments), and controls were subjects with Ն10 mmHg decreases from pre-to posthemodialysis in at least four of six treatments. The primary outcome was mean interdialytic 44-hour systolic ambulatory BP.Results Fifty subjects with a mean age of 54.5 years were enrolled (25 per group) among whom 80% were men, 86% diabetic, 62% Hispanic, and 38% African American. The mean prehemodialysis systolic BP for the intradialytic-hypertension and control groups were 144.0 and 155.5 mmHg, respectively. Mean posthemodialysis systolic BP was 159.0 and 128.1 mmHg, for the intradialytic-hypertension and control groups, respectively. The mean systolic ambulatory BP was 155.4 and 142.4 mmHg for the intradialytic-hypertension and control groups, respectively (P ϭ 0.005). Both daytime and nocturnal systolic BP were higher among those with intradialytic hypertension as compared with controls. There was no difference in interdialytic weight gain between groups.Conclusions Time-integrated BP burden as measured by 44-hour ambulatory BP is higher in hemodialysis patients with intradialytic hypertension than those without intradialytic hypertension.

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Blood pressure during the interdialytic period in haemodialysis patients: estimation of representative blood pressure values

Cited by 93 publications

References 0 publications

Changing Relationship of Blood Pressure with Mortality over Time among Hemodialysis Patients

Changing Relationship of Blood Pressure with Mortality over Time among Hemodialysis Patients

Blood Pressure Control before and after Starting Dialysis

Intradialytic Hypertension and the Association with Interdialytic Ambulatory Blood Pressure

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