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Systolic blood pressure and mortality in prevalent haemodialysis patients in the HEMO study

Journal of Human Hypertension volume 25, pages 98–105 (2011)Cite this article

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Abstract

Previous studies of blood pressure and mortality in haemodialysis have yielded mixed results, perhaps due to confounding by comorbid conditions. We hypothesized that after improved accounting for confounding factors, higher systolic blood pressure (SBP) would be associated with higher all-cause mortality. We conducted a secondary analysis of data from the haemodialysis study, a randomized trial in prevalent haemodialysis patients. We used three proportional hazard models to determine the relative hazard at different levels of SBP: (1) Model-BL used baseline SBP; (2) Model-TV used SBP as a time-varying variable; and (3) Model-TV-Lag added a 3-month lag to Model-TV to de-emphasize changes in SBP associated with acute illness. In all the models, pre-dialysis SBP <120 mm Hg was associated with a higher risk of mortality compared with the referent group (140–159 mm Hg); higher pre-dialysis SBP was not associated with higher risk of mortality. In conclusion, we observed a robust association between lower pre-dialysis SBP and higher risk for all-cause and cardiovascular mortality in a well-characterized cohort of prevalent haemodialysis patients. Randomized clinical trials are needed to define optimal blood pressure targets in the haemodialysis population.

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Acknowledgements

Dr Chang is supported by a Ruth L Kirschstein National Research Service Award (NRSA) Institutional Research Training Grant (5 T32 DK7357).

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Authors and Affiliations

  1. Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA

    T I Chang & G M Chertow

  2. Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA, USA

    G D Friedman

  3. Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA

    A K Cheung

  4. Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA

    A K Cheung

  5. Research Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA

    T Greene

  6. Division of Epidemiology, University of Utah, Salt Lake City, UT, USA

    T Greene

  7. Division of General Internal Medicine, Stanford University School of Medicine, Palo Alto, CA, USA

    M Desai

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  1. T I Chang
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Correspondence to T I Chang.

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The authors declare no conflict of interest.

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An abstract based on these data was presented as a free communication at the 2009 American Society of Nephrology Annual Meeting in San Diego, CA, USA.

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Chang, T., Friedman, G., Cheung, A. et al. Systolic blood pressure and mortality in prevalent haemodialysis patients in the HEMO study. J Hum Hypertens 25, 98–105 (2011). https://doi.org/10.1038/jhh.2010.42

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  • DOI: https://doi.org/10.1038/jhh.2010.42

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