'U' curve association of blood pressure and mortality in hemodialysis patients

Philip G. Zager, Jovanka Nikolic, Richard H. Brown, Marilyn A. Campbell, William C. Hunt, Darwin Peterson, John Van Stone, Andrew Levey, Klemens B. Meyer, Michael J. Klag, H. Keith Johnson, Eugene Clark, John H. Sadler, Pradip Teredesai

Research output: Contribution to journalArticlepeer-review

556 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)561-569
Number of pages9
JournalKidney international
Issue number2
StatePublished - 1998
Externally publishedYes


  • Anti-hypertensive drugs
  • Cardiovascular/cerebrovascular mortality
  • Dialysis
  • Hypertension
  • Survival

ASJC Scopus subject areas

  • Nephrology


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