Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States.
BACKGROUND
Hypertension is common in chronic hemodialysis patients, yet there are limited data on the epidemiology of hypertension in these patients in the United States.


METHODS
We assessed the prevalence, treatment, and control of hypertension in a cohort of 2535 clinically stable, adult hemodialysis patients who participated in a multicenter study of the safety and tolerability of an intravenous iron preparation. Hypertension was defined as an average predialysis systolic blood pressure >150 mm Hg or diastolic blood pressure >85 mm Hg, or the use of antihypertensive medications.


RESULTS
Hypertension was documented in 86% (n = 2173) of patients. The prevalence of hypertension, in contrast to that observed in the general population, did not increase linearly with age and was not affected by sex or ethnicity. Hypertension was controlled adequately in only 30% (n = 659) of the hypertensive patients. In the remaining patients, hypertension was either untreated (12% [252/2173]) or treated inadequately (58% [1262/2173]).


CONCLUSIONS
Control of hypertension, particularly systolic hypertension, in chronic hemodialysis patients in the United States is inadequate, despite recognition of its prevalence and the frequent use of antihypertensive drugs. Optimizing the use of medications and closer attention to nonpharmacologic interventions, such as adjustment of dry weight, a low-sodium diet, and exercise, may improve control.
Agarwal
Rajiv
R
Division of Nephrology, Department of Medicine, Indiana University School of Medicine, and RLR VA Medical Center, Indianapolis 46202, USA. ragarwal@iupui.edu
Nissenson
Allen R
AR
Batlle
Daniel
D
Coyne
Daniel W
DW
Trout
J Richard
JR
Warnock
David G
DG
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D015331:Cohort Studies; D018592:Cross-Over Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D003971:Diastole / Q000187:drug effects / Q000502:physiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis; D013223:Statistics as Topic; D013599:Systole / Q000187:drug effects / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers