Factors associated with inadequate blood pressure control in hypertensive hemodialysis patients

Hypertension is common in hemodialysis patients and increases cardiovascula r morbidity and mortality. We determined the prevalence of inadequate contr ol of hypertension in 489 patients receiving hemodialysis and identified fa ctors associated with uncontrolled hypertension. We interviewed the patient s and abstracted demographic and clinical information from a computerized d atabase, The prevalence of uncontrolled hypertension (average predialysis b lood pressure, greater than or equal to 160/90 mm Hg) was 62%, Ninety-one p ercent of patients with uncontrolled hypertension were receiving submaximal antihypertensive drug therapy, and 59% withheld their medications before d ialysis, Uncontrolled hypertensives had a greater interdialytic weight gain (3.8% v 3.5%, P = 0.07) end a greater excess weight gain (3.1 +/- 1.6 kg v 2.5 +/- 1.4 kg; P < 0.05) compared with controlled hypertensives, Patients with uncontrolled hypertension showed higher interdialytic weight gain (2. 7 +/- 0.06 kg v 2.2 +/- 0.13 kg; P < 0.05), were more likely to be black (9 4% v 81%; P < 0.05), were more likely to have hypertension as the cause of their end stage renal disease (ESRD) (42% v 24%; P < 0.05), and had been re ceiving hemodialysis for a shorter time (4.3 +/- 2 yr v 6.1 +/- 0.9 yr; P < 0.05) compared with normotensive patients. There was significant correlati on between diastolic blood pressure and both interdialytic weight gain (r = 0.31, P < 0.05) and percent weight gain (r = 0.34, P < 0.05) in the hypert ensive but not in the normotensive patients (r = -0.21), Interdialytic weig ht gain and hypertension as a cause of ESRD were independent predictors of predialysis systolic blood pressure. We conclude that hypertension is uncon trolled in most patients undergoing hemodialysis. Submaximal antihypertensi ve therapy, excessive interdialytic weight gain, and withholding antihypert ensive medication before dialysis are correctable factors potentially contr ibuting to uncontrolled hypertension.