Hypertension in the hemodialysis patient

CORRESPONDENCE

563

HYPERTENSION IN THE HEMODIALYSIS PATIENT To the Editor: In response to a recent editorial by Mailloux,1 ‘‘Hypertension in the Dialysis Patient,’’ we would like to share our experience. The Brighton renal unit serves a predominantly white population of 1.3 million in southeast England. We analyzed the available blood pressure data obtained during maintenance hemodialysis for 108 patients who are dialyzed 3 days a week for 3 to 4 hours each day. Using patients’ notes, dialysis forms, and nursing evaluation forms, data were collected retrospectively for a period between October 1, 1998, and December 31, 1998. A mean of all available readings throughout that period was calculated to compare individual variables. Results were compared with the recommended standards set by the Joint Committee of the Royal College of Physicians and the British Renal Association (ie, ⬍140/90 mm Hg in patients ⬍60 years and ⬍160/90 mm Hg in patients ⬎60 years).2 There were 66 men, 35 smokers (including past and present smokers), and 20 patients with diabetes. Mean age of the patients was 61 years. It is interesting to note that it was easier to achieve the recommendations in the elderly population (⬎60 years) than in the young, which is similar to an earlier report by Salem.3 Sixty-five patients were receiving antihypertensive medications, and 27 patients (42%) required two or more medications for blood pressure control. No statistically significant effect of sex, smoking habit, diabetes, or interdialytic weight gain was noted on blood pressure control (Table 1). There was also no significant relationship between mean arterial blood pressure and body mass index, dose of erythropoietin, or number of comorbid conditions (Table 2). The Tassin experience has shown that it may take more than 10 years for the benefits of ideal blood pressure control in the dialysis population to manifest in the form of improvement in mortality and morbidity.4 This suggests that more aggressive control of blood pressure in the younger population may be beneficial. We are planning to study prospectively the effect of good blood pressure control on cardiovascular morbidity and mortality in our dialysis population, with special emphasis on the young. Debasish Bandyopadhyay, MD Jane Cox, BSc Wendy Harman, RGN Neil Iggo, MRCP Christopher Kingswood, FRCP Paul Sharpstone, FRCP Department of Renal Medicine Royal Sussex County Hospital Brighton, United Kingdom

Table 1. Blood Pressure Control and Variables

Covariants

Good BP Control*

Poor BP Control*

49 19 45 23 16 36 12 56

15 25 21 19 18 19 8 32

16

14

13

9

Age ⬎60 y Age ⬍60 y Men Women Smokers Nonsmokers Diabetics Nondiabetics Interdialytic weight gain ⬎1 kg Interdialytic weight gain ⬍1 kg

P

⬍0.01 0.16 0.09 0.76

0.68

NOTE. Values expressed as number of patients. Abbreviation: BP, blood pressure. *Blood pressure control as defined in text.2

Table 2. Relationship of Mean Arterial Blood Pressure With Variables

Covariants

Correlation Coefficient (r )

P

Body mass index Dose of erythropoietin No. of comorbid conditions

0.009 0.009 ⫺0.056

0.94 0.09 0.56

REFERENCES 1. Mailloux LU: Hypertension in the dialysis patient. Am J Kidney Dis 34:359-361, 1999 2. Cameron JS: Treatment of Adult Patients with Renal Failure; Recommended Standards and Audit Measures. The Renal Association and the Royal College of Physicians of London (ed 2). 1997, p 26 3. Salem MM: Hypertension in the hemodialysis population: A survey of 649 patients. Am J Kidney Dis 26:461-468, 1995 4. Charra B, Calemard E, Ruffet M, Chazot C, Terrat J-C, Vanel T, Laurent G: Survival as an index of adequacy of dialysis. Kidney Int 41:1286-1291, 1992