Risk factors for hypertension in chronic hemodialysis patients: baseline data from the HEMO study.
A cross-sectional analysis was performed to determine risk factors associated with hypertension in 1,238 chronic hemodialysis patients upon enrollment into the HEMO Study. The mean pre- and post-dialysis systolic blood pressure were 152.4 +/- 25.0 (mean +/- SD) and 137.8 +/- 24.6 mm Hg, respectively. The mean pre- and post-dialysis diastolic blood pressures were 82.1 +/- 14.8 and 74.7 +/- 13.8 mm Hg, respectively. Less than 30% of the study cohort had blood pressures that were normotensive by JNC VI guidelines. Risk factors associated with higher pre- and post-dialysis systolic blood pressures included the presence of diabetes mellitus, older age, increased number of prescribed antihypertensive medications, lower hematocrit, and absence of arrhythmias. Variables associated with higher pre- and post-dialysis diastolic blood pressures included younger age, increased number of prescribed anti-hypertensive medications and absence of arrhythmias. There was also a nonlinear relationship between blood pressure and prescribed total ultrafiltration volume. A total ultrafiltration volume of >2.5 kg was associated with an elevation in pre-dialysis systolic and diastolic blood pressures. A total ultrafiltration volume of < or =2.5 kg was associated with an elevation in post-dialysis systolic and diastolic blood pressures. These data on ultrafiltration volume suggest that higher pre-dialysis blood pressures may be associated with excessive interdialytic weight gains due to patient noncompliance with fluid restriction and that higher post-dialysis blood pressures may be associated with a prescribed dry weight that is higher than the patient's true dry weight. Better management of these parameters may improve the prevalence and severity of hypertension in this population.
Rocco
M V
MV
Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1053, USA. mrocco@wfubmc.edu
Yan
G
G
Heyka
R J
RJ
Benz
R
R
Cheung
A K
AK
D002986:Clinical Trials as Topic; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D006435:Renal Dialysis; D012307:Risk Factors