Nephrology Dialysis Transplantation, Vol 14, Issue 6 1536-1540, Copyright © 1999 by Oxford University Press
R Cocchi, E Esposti, A Fabbri, A Lucatello, A Sturani, F Quarello, R Boero, M Bruno, C Dadone, A Favazza, R Scanziani, A Tommasi and A Giangrande
Background: the tenet that peritoneal dialysis is
capable of either normalizing or improving blood pressure control in
uraemic patients is based on outdated or monocentric experiences.
Therefore, we assessed the prevalence of hypertension and the efficacy of
antihypertensive therapy in a large, multicentric cohort of patients on
peritoneal dialysis. Methods: Twenty seven out of the
50 centres belonging to the Italian Co-operative Peritoneal Dialysis Study
Group took part in the study. The main patient selection criteria were:
peritoneal dialysis therapy for at least 3 months and no peritonitis or
changes in dialysis technique for at least 1 month. Clinical blood pressure
was measured according to WHO/ISH guidelines. Ambulatory blood pressure
monitoring was carried out using a SpaceLabs 90207 recorder. Hypertension
was defined according to WHO/ISH criteria and staged according to the
criteria of the Joint National Committee on Detection, Evaluation and
Treatment of High Blood Pressure (JNC), 5th Report. Ambulatory blood
pressure monitoring recordings were used to evaluate white-coat
hypertension, blood pressure load and the dipping phenomenon.
Results: Five hundred and four subjects were
evaluated. Hypertension was prevalent in 88.1% of the population, and 362
out of 444 hypertensive patients were on antihypertensive therapy. JNC
staging revealed that 188 patients had moderate to severe hypertension.
Blood pressure load was pathological in 77.3% of the patients receiving
antihypertensive treatment. White-coat hypertension was identified in 9.1%
of the hypertensive patients not on antihypertensive therapy, and 53.1% of
the patients were non-dippers. Conclusion: The study
demonstrates that hypertension is a dramatic, unsolved problem in uraemic
patients treated with peritoneal dialysis, and casts doubts on the
effectiveness of our current peritoneal dialysis strategies and
pharmacological management of hypertension. Key words:
ambulatory blood pressure monitoring; antihypertensive therapy; prevalence
of hypertension; peritoneal dialysis; white-coat hypertension
ORIGINAL ARTICLES
Prevalence of hypertension in patients on peritoneal dialysis: results of an Italian multicentre study
Departments of Nephrology and Dialysis, S Maria delle Croci Hospital, Viale Randi, 5, I-48100 Ravenna, Italy; G Bosco Hospital, Turin, Italy; Italian Co-operative Peritoneal Dialysis Study Group (ICPDSG), Scientific Committee, Italy; Corresponding author
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