Background: The epidemiology of hypertension among hemodialysis (HD) patients is difficult to describe accurately because of difficulties in the assessment of blood pressure (BP). Methods: Using 44-hour interdialytic ambulatory BP measurements, we describe the epidemiology of hypertension in a cohort of 369 patients. To seek correlates of hypertension control, antihypertensive agents were withdrawn among patients with controlled hypertension and ambulatory BP monitoring was repeated. Results: Hypertension (defined as an average ambulatory systolic BP ≧135 mm Hg or diastolic BP ≧85 mm Hg, or the use of antihypertensive medications) was prevalent in 82% of the patients and independently associated with epoetin use, lower body mass index and fewer years on dialysis. Although 89% of the patients were being treated, hypertension was controlled adequately in only 38%. Poor control was independently associated with greater antihypertensive drug use. Inferior vena cava (IVC) diameter in expiration was associated with increased risk of poorly controlled hypertension both in cross-sectional analysis and after withdrawal of antihypertensive drugs. Conclusions: Interdialytic hypertension is highly prevalent and difficult to control among HD patients. End-expiration IVC diameter is associated with poor control of hypertension in cross-sectional analyses as well as after washout of antihypertensive drugs. Among HD patients, an attractive target for improving hypertension control appears to be the reduction of extracellular fluid volume.

Keywords:
Vitamin D receptor activators, Ambulatory blood pressure monitoring, Epidemiology, Epoetin, Hemodialysis, Hypertension
1.
Salem MM: Hypertension in the hemodialysis population: a survey of 649 patients. Am J Kidney Dis 1995;26:461–468.
2.
Agarwal R, Nissenson AR, Batlle D, Coyne DW, Trout JR, Warnock DG: Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States. Am J Med 2003;115:291–297.
3.
Rocco MV, Yan G, Heyka RJ, Benz R, Cheung AK: Risk factors for hypertension in chronic hemodialysis patients: baseline data from the HEMO study. Am J Nephrol 2001;21:280–288.
4.
Raine AE, Margreiter R, Brunner FP, Ehrich JH, Geerlings W, Landais P, Loirat C, Mallick NP, Selwood NH, Tufveson G: Report on management of renal failure in Europe, XXII, 1991. Nephrol Dial Transplant 1992;7(suppl 2):7–35.
5.
Agarwal R, Peixoto AJ, Santos SF, Zoccali C: Pre- and postdialysis blood pressures are imprecise estimates of interdialytic ambulatory blood pressure. Clin J Am Soc Nephrol 2006;1:389–398.
6.
Agarwal R, Brim NJ, Mahenthiran J, Andersen MJ, Saha C: Out-of-hemodialysis-unit blood pressure is a superior determinant of left ventricular hypertrophy. Hypertension 2006;47:62–68.
7.
Alborzi P, Patel N, Agarwal R: Home blood pressures are of greater prognostic value than hemodialysis unit recordings. Clin J Am Soc Nephrol 2007;2:1228–1234.
8.
Agarwal R: Blood pressure and mortality among hemodialysis patients. Hypertension 2010;55:762–768.
9.
Agarwal R, Weir MR: Dry-weight: a concept revisited in an effort to avoid medication-directed approaches for blood pressure control in hemodialysis patients. Clin J Am Soc Nephrol 2010;5:1255–1260.
10.
Agarwal R, Andersen MJ, Bishu K, Saha C: Home blood pressure monitoring improves the diagnosis of hypertension in hemodialysis patients. Kidney Int 2006;69:900–906.
11.
Agarwal R: Supervised atenolol therapy in the management of hemodialysis hypertension. Kidney Int 1999;55:1528–1535.
12.
Sahn DJ, DeMaria A, Kisslo J, Weyman A: Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978;58:1072–1083.
13.
Agarwal R, Bouldin JM, Light RP, Garg A: Inferior vena cava diameter and left atrial diameter measure volume but not dry weight. Clin J Am Soc Nephrol 2011;6:1066–1072.
14.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560–2572.
15.
K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 2005;45:S1–S153.
16.
Krapf R, Hulter HN: Arterial hypertension induced by erythropoietin and erythropoiesis-stimulating agents (ESA). Clin J Am Soc Nephrol 2009;4:470–480.
17.
Hand MF, Haynes WG, Johnstone HA, Anderton JL, Webb DJ: Erythropoietin enhances vascular responsiveness to norepinephrine in renal failure. Kidney Int 1995;48:806–813.
18.
Bode-Boger SM, Boger RH, Kuhn M, Radermacher J, Frolich JC: Recombinant human erythropoietin enhances vasoconstrictor tone via endothelin-1 and constrictor prostanoids. Kidney Int 1996;50:1255–1261.
19.
Li Z, Lacson E Jr, Lowrie EG, Ofsthun NJ, Kuhlmann MK, Lazarus JM, Levin NW: The epidemiology of systolic blood pressure and death risk in hemodialysis patients. Am J Kidney Dis 2006;48:606–615.
20.
Port FK, Hulbert-Shearon TE, Wolfe RA, Bloembergen WE, Golper TA, Agodoa, LY, Young EW: Predialysis blood pressure and mortality risk in a national sample of maintenance hemodialysis patients. Am J Kidney Dis 1999;33:507–517.
21.
Daul AE, Wang XL, Michel MC, Brodde OE: Arterial hypotension in chronic hemodialyzed patients. Kidney Int 1987;32:728–735.
22.
Esforzado AN, Cases AA, Bono IM, Gaya BJ, Calls GJ, Rivera FF: Autonomic nervous system and adrenergic receptors in chronic hypotensive haemodialysis patients. Nephrol Dial Transplant 1997;12:939–944.
23.
Xu J, Li G, Wang P, Velazquez H, Yao X, Li Y, Wu Y, Peixoto A, Crowley S, Desir GV: Renalase is a novel, soluble monoamine oxidase that regulates cardiac function and blood pressure. J Clin Invest 2005;115:1275–1280.
24.
Caravaca F, Pizarro JL, Arrobas M, Cubero JJ, Garcia MC, Perez-Miranda M: Antiplatelet therapy and development of hypertension induced by recombinant human erythropoietin in uremic patients. Kidney Int 1994;45:845–851.
25.
Bodyak N, Ayus JC, Achinger S, Shivalingappa V, Ke Q, Chen YS, Rigor DL, Stillman I, Tamez H, Kroeger PE, Wu-Wong RR, Karumanchi SA, Thadhani R, Kang PM: Activated vitamin D attenuates left ventricular abnormalities induced by dietary sodium in Dahl salt-sensitive animals. Proc Natl Acad Sci USA 2007;104:16810–16815.
26.
de Zeeuw D, Agarwal R, Amdahl M, Audhya P, Coyne D, Garimella T, Parving HH, Pritchett Y, Remuzzi G, Ritz E, Andress D: Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study): a randomised controlled trial. Lancet 2010;376:1543–1551.
27.
Raine AEG, Bedford L, Simpson AWM, Ashley CC, Brown R, Woodhead JS, Ledingham JGG: Hyperparathyroidism, platelet intracellular free calcium and hypertension in chronic renal failure. Kidney Int 1993;43:700–705.
28.
Goldsmith DJA, Covic AA, Venning MC, Ackrill P: Blood pressure reduction after parathyroidectomy for secondary hyperparathyroidism: further evidence implicating calcium homeostasis in blood pressure regulation. Am J Kidney Dis 1996;27:819–825.
29.
Vertes V, Cangiano JL, Berman LB, Gould A: Hypertension in end-stage renal disease. N Engl J Med 1969;280:978–981.
30.
Satyan S, Light RP, Agarwal R: Relationships of N-terminal pro-B-natriuretic peptide and cardiac troponin T to left ventricular mass and function and mortality in asymptomatic hemodialysis patients. Am J Kidney Dis 2007;50:1009–1019.
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2011
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