TY - JOUR
T1 - 'U' curve association of blood pressure and mortality in hemodialysis patients
AU - Zager, Philip G.
AU - Nikolic, Jovanka
AU - Brown, Richard H.
AU - Campbell, Marilyn A.
AU - Hunt, William C.
AU - Peterson, Darwin
AU - Van Stone, John
AU - Levey, Andrew
AU - Meyer, Klemens B.
AU - Klag, Michael J.
AU - Johnson, H. Keith
AU - Clark, Eugene
AU - Sadler, John H.
AU - Teredesai, Pradip
N1 - Funding Information:
The present study was funded by Dialysis Clinic, Inc. (DCI), a not-for-profit dialysis corporation. The authors thank all DCI facilities and medical directors for their collaborative assistance; and Ms. Rita Elliott for excellent editorial comments.
PY - 1998
Y1 - 1998
N2 - Background. Hypertension may play an important role in the pathogenesis of the excess cardiovascular and cerebrovascular (CV) morbidity observed in hemodialysis patients (HD). However, the optimal blood pressure (BP) range for HD patients has not been defined. We postulated that there is a 'U' curve relationship between BP anti CV mortality. To explore this hypothesis we studied 5,433 HD patients in Dialysis Clinic Inc., a large not-for-profit chain, over a five year period. Methods. Cox regression, with fixed and time- varying covariates, was used to assess the effect of systolic blood pressure (SBP) and diastolic blood pressure (DBP), pre- and post-dialysis, on CV mortality, while adjusting for age, gender, ethnicity, primary cause of end- stage renal disease, Kt/V, serum albumin, and antihypertensive medications. Results. The overall impact of BP on CV mortality was modest. Pre-dialysis, neither systolic nor diastolic hypertension were associated with an increase in CV mortality. Post-dialysis, SBP ≤ 180 mm Hg (RR = 1.96, P < 0.015) and DBP ≤ 90 mm Hg (RR = 1.73, P < 0.05) were associated with increased CV mortality. Low SBP (SBP < 110 mm Hg) was associated with increased CV mortality, pre- and post-dialysis. Conclusions. The results suggest the presence of a 'U' curve relationship between SBP post-dialysis and CV mortality in HD patients.
AB - Background. Hypertension may play an important role in the pathogenesis of the excess cardiovascular and cerebrovascular (CV) morbidity observed in hemodialysis patients (HD). However, the optimal blood pressure (BP) range for HD patients has not been defined. We postulated that there is a 'U' curve relationship between BP anti CV mortality. To explore this hypothesis we studied 5,433 HD patients in Dialysis Clinic Inc., a large not-for-profit chain, over a five year period. Methods. Cox regression, with fixed and time- varying covariates, was used to assess the effect of systolic blood pressure (SBP) and diastolic blood pressure (DBP), pre- and post-dialysis, on CV mortality, while adjusting for age, gender, ethnicity, primary cause of end- stage renal disease, Kt/V, serum albumin, and antihypertensive medications. Results. The overall impact of BP on CV mortality was modest. Pre-dialysis, neither systolic nor diastolic hypertension were associated with an increase in CV mortality. Post-dialysis, SBP ≤ 180 mm Hg (RR = 1.96, P < 0.015) and DBP ≤ 90 mm Hg (RR = 1.73, P < 0.05) were associated with increased CV mortality. Low SBP (SBP < 110 mm Hg) was associated with increased CV mortality, pre- and post-dialysis. Conclusions. The results suggest the presence of a 'U' curve relationship between SBP post-dialysis and CV mortality in HD patients.
KW - Anti-hypertensive drugs
KW - Cardiovascular/cerebrovascular mortality
KW - Dialysis
KW - Hypertension
KW - Survival
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U2 - 10.1046/j.1523-1755.1998.00005.x
DO - 10.1046/j.1523-1755.1998.00005.x
M3 - Article
C2 - 9690224
AN - SCOPUS:7344265050
SN - 0085-2538
VL - 54
SP - 561
EP - 569
JO - Kidney international
JF - Kidney international
IS - 2
ER -