title: Treating hypertension in hemodialysis improves symptoms seemingly unrelated to volume excess.
abstract: BACKGROUND
  Among hemodialysis patients, probing dry weight is an effective strategy for improving control of hypertension. Whether controlling hypertension improves or worsens symptoms among such patients remains unclear. The purpose of the study was to develop a tool to evaluate symptoms and examine the relationship of the change in these symptoms with blood pressure (BP) control.
  
  
  METHODS
  Among patients participating in the Hemodialysis Patients Treated with Atenolol or Lisinopril (HDPAL) randomized controlled trial, a confirmatory factor analysis (CFA) was performed to establish the relationship between symptoms and organ systems. Next, the change in symptom scores pertaining to organ systems was analyzed using a mixed model. Finally, the independent effect of lowering home BP on change in symptoms was evaluated.
  
  
  RESULTS
  Among 133 participants where symptoms were available at baseline, CFA revealed four level 1 domains: gastrointestinal symptoms, dialysis-related symptoms, cardiovascular symptoms and general symptoms. All except dialysis-related symptoms were ascribed to uremia (level 2 domain). Uremic symptoms improved over 6 months and then increased. Dialysis-related symptoms (fatigue, cramps and orthostatic dizziness) did not worsen despite lowering home BP. Probing dry weight was independently associated with an improvement in cardiovascular symptoms such as shortness of breath.
  
  
  CONCLUSIONS
  Reducing BP through the use of a strategy that includes volume control and medication improves symptoms seemingly unrelated to volume excess. In long-term hemodialysis patients, treating hypertension using home BP measurements may improve well-being.
authors.affiliation: Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Administration Medical Center, Indianapolis, IN, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Agarwal
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D001794:Blood Pressure; D001810:Blood Volume; D001835:Body Weight; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy; D017706:Lisinopril / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D001262:Atenolol; D017706:Lisinopril
keywords: blood pressure; cardiovascular; hemodialysis; hypertension; symptoms