Prevalence of hypertension and adequacy of blood pressure control in hemodialysis patients

To investigate the prevalence and adequacy of blood pressure control in hemodialysis patients, we studied 96 patients in a full-care dialysis unit. The average of 3 blood pressures taken pre- and post-dialysis for 3 consecutive dialysis sessions in 1 week was taken as the blood pressure. Patients were classified as hypertensive if their pre- or post-dialysis systolic or diastolic blood pressure was >150 mmHg or >90 mm Hg, respectively, or if they were on antihypertensive medications. Blood pressure control was defined as systolic blood pressure less than or equal to 150 mmHg and diastolic blood pressure less than or equal to 90 mm Hg both pre- and post-dialysis, with or without antihypertensive medications. Ninety-two of 96 patients (96%) had hypertension. Blood pressure was controlled in 28 patients (29%). Age, race, sex, average volumes removed at dialysis, hematocrit, erythropoietin use, vitamin D use, average Kt/V, use of high-flux dialyzers, intact PTH level, use of programmable sodium, hours on dialysis, months on dialysis, or current smoking history did not have a significant relation to blood pressure control. Our study shows a very high prevalence of high blood pressure in hemodialysis patients as we enter a new century, and that blood pressure is not controlled in the majority of patients. This may explain, at least in part, the reason for continued high cardiovascular morbidity and mortality in dialysis patients.