Nephrology Dialysis Transplantation, Vol 14, Issue 1 125-128, Copyright © 1999 by Oxford University Press
M Salem
Background: Few studies have quantified the effect of
hypertension on survival in haemodialysis (HD) population. We have
previously reported lack of adverse effect of hypertension on 1-year
mortality in a cohort of 649 haemodialysis patients (Am J Kidney
Dis 1996; 28: 737-744). We report here the effect of
hypertension on 2-year survival in the same cohort of patients.
Methods: We reviewed the complete computerized files
on 649 HD patients enrolled in 10 haemodialysis centres in the state of
Mississippi, USA. One-month dialysis records for each patient from
mid-October 1994 to mid-November 1994 were reviewed. Predialysis mean
arterial pressure was calculated as immediate predialysis diastolic
pressure plus one-third the difference between systolic and diastolic
pressure. Patients were classified as hypertensive if their average preMAP
was more than 114 mmHg or they were receiving antihypertensive drugs during
the study period. Normotensives had a pre-MAP <114 and were not
receiving any antihypertensives. We followed these patients for 2 years to
determine their survival and the effect of their BP status, as determined
in October 1994, on 2-year mortality. Results: In
univariate analysis, hypertension was associated with improved 2-years
survival (relative risk 0.64, P=0.08 compared to normotensives).
Furthermore, among the hypertensives, good blood pressure control (less
than 140/90) was associated with increased relative risk of death at 2
years (RR 1.86, P=0.004). In multivariate analysis, taking age, race, serum
albumin, and diabetic status into consideration, there was a 27% reduction
in mortality among hypertensives compared to normotensives (RR 0.73,
P=0.06). Other factors of significance in multivariate analysis were age
(RR 1.03/year, P=0.02), serum albumin (RR 0.36/g, P<0.0001),
diabetes mellitus (RR 1.35, P=0.07), and race (RR 0.64, P=0.05).
Conclusions: Our study suggests that hypertension has
no adverse effect on survival at 2 years in the haemodialysis population.
Key words: antihypertensives; chronic renal failure;
end-stage renal disease; haemodialysis; hypertension; mortality; survival
ORIGINAL ARTICLES
Hypertension in the haemodialysis population: any relationship to 2-years survival?
University of Mississippi Medical Centre, 2500 North State Street, Jackson, MS 39216, USA
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