IMPACT OF HYPERTENSION ON CARDIOMYOPATHY, MORBIDITY AND MORTALITY IN END-STAGE RENAL-DISEASE

A cohort of 432 ESRD (261 hemodialysis and 171 peritoneal dialysis) pa tients was followed prospectively for an average of 41 months. Baselin e and annual demographic, clinical and echocardiographic assessments w ere performed, as well as serial clinical and laboratory tests measure d monthly while on dialysis therapy. The average mean arterial blood p ressure level during dialysis therapy was 101 +/- 11 mm Hg. After adju sting for age, diabetes and ischemic heart disease, as well as hemoglo bin and serum albumin levels measured serially, each 10 mm Hg rise in mean arterial blood pressure was independently associated with: the pr esence of concentric LV hypertrophy (OR 1.48, P = 0.02), the change in LV mass index (beta = 5.4 g/m(2), P = 0.027) and cavity volume (beta = 4.3 ml/m(2), P = 0.048) on follow-up echocardiography, the developme nt of de novo cardiac failure (RR 1.44, P = 0.007), and the developmen t of de novo ischemic heart disease (RR 1.39, P = 0.05). The associati on with LV dilation was of borderline statistical significance (OR 1.4 8, P = 0.06). Mean arterial blood pressures greater than 106 mm Hg wer e associated with both echocardiographic and clinical endpoints. Parad oxically, low mean arterial blood pressure (RR 1.36 per 10 mm Hg fall, P = 0.009) was independently associated with mortality. The associati on of low blood pressure with mortality was a marker for having had ca rdiac failure prior to death. We conclude that even moderate hypertens ion worsens the echocardiographic and clinical outcome in ESRD patient s, especially in those without previous clinical cardiac disease.