Clinical study
Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States

https://doi.org/10.1016/S0002-9343(03)00366-8Get rights and content

Abstract

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]).

Conclusion

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.

Section snippets

Methods

This study is based on a large cohort of hemodialysis patients enrolled in a crossover, randomized, double-blind study of the safety and tolerability of sodium ferric gluconate in sucrose (Ferrlecit; Watson Pharma, Salt Lake City, Utah) versus placebo (6). Patients were enrolled at 69 centers in the United States between August 1999 and October 2000. Approval was obtained from the respective Institutional Review Boards.

Eligible patients were stable, adult chronic hemodialysis patients who had

Results

Patients in the sample were slightly younger (mean [± SD] age, 56 ± 15 years) compared with the U.S. dialysis population (Table 2). There were also more blacks and Hispanics. The average duration on dialysis was about 4 years. Less than 15% of patients were normotensive, and only 30% of those with hypertension had adequately controlled blood pressure (Table 3). The prevalence of hypertension was not affected by ethnicity (P >0.20) or sex (P >0.20) (Figure 1), but was increased in younger

Discussion

We found that hypertension, particularly systolic hypertension, was common in our sample of hemodialysis patients who comprised nearly 1.2% of the total hemodialysis population in the United States. Although the majority was treated, less than one third achieved adequate blood pressure control.

Blood pressure varies greatly during the interdialytic period, and routine measurements often overestimate blood pressure (10). We therefore used definitions of hypertension that have been validated in

References (43)

  • N. Mazzuchi et al.

    Importance of blood pressure control in hemodialysis patient survival

    Kidney Int

    (2000)
  • B. Charra et al.

    Survival as an index of adequacy of dialysis

    Kidney Int

    (1992)
  • M. Rahman et al.

    Factors associated with inadequate blood pressure control in hypertensive hemodialysis patients

    Am J Kidney Dis

    (1999)
  • R. Agarwal

    Supervised atenolol therapy in management of hemodialysis hypertension

    Kidney Int

    (1999)
  • R. Agarwal et al.

    Lisinopril therapy for hemodialysis hypertension–hemodynamic and endocrine responses

    Am J Kidney Dis

    (2001)
  • M. Rahman et al.

    Interdialytic weight gain, compliance with dialysis regimen, and age are independent predictors of blood pressure in hemodialysis patients

    Am J Kidney Dis

    (2000)
  • R. Saracho et al.

    Evaluation of the Losartan in Hemodialysis (ELHE) study

    Kidney Int Suppl

    (1998)
  • J.K. Leypoldt et al.

    Relationship between volume status and blood pressure during chronic hemodialysis

    Kidney Int

    (2002)
  • B. Michael et al.

    Sodium ferric gluconate complex in hemodialysis patientsadverse reactions compared to placebo and iron dextran

    Kidney Int

    (2002)
  • D.J. Hyman et al.

    Characteristics of patients with uncontrolled hypertension in the United States

    N Engl J Med

    (2001)
  • M.V. Rocco et al.

    Risk factors for hypertension in chronic hemodialysis patientsbaseline data from the HEMO study

    Am J Nephrol

    (2001)
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