Prevalence of hypertension in patients on peritoneal dialysis: results of an Italian multicentre study

Background. The tenet that peritoneal dialysis is capable of either normali zing or improving blood pressure control in uraemic patients is based on ou tdated or monocentric experiences. Therefore, we assessed the prevalence of hypertension and the efficacy of antihypertensive therapy in a large, mult icentric cohort of patients on peritoneal dialysis. Methods. Twenty seven out of the 50 centres belonging to the Italian Go-ope rative Peritoneal Dialysis Study Group took part in the study. The main pat ient selection criteria were: peritoneal dialysis therapy for at least 3 mo nths and no peritonitis or changes in dialysis technique for at least 1 mon th. Clinical blood pressure was measured according to WHO/ISM guidelines. A mbulatory blood pressure monitoring was carried out using a SpaceLabs 90207 recorder. Hypertension was defined according to WHO/ISM criteria and stage d according to the criteria of the Joint National Committee on Detection, E valuation and Treatment of High Blood Pressure (JNC), 5th Report. Ambulator y blood pressure monitoring recordings were used to evaluate white-coat hyp ertension, blood pressure load and the dipping phenomenon. Results. Five hundred and four subjects were evaluated. Hypertension was pr evalent in 88.1% of the population, and 362 out of 444 hypertensive patient s were on antihypertensive therapy. JNC staging revealed that 188 patients had moderate to severe hypertension. Blood pressure load was pathological i n 77.3% of the patients receiving antihypertensive treatment. White-coat hy pertension was identified in 9.1% of the hypertensive patients not on antih ypertensive therapy, and 53.1% of the patients were non-dippers. Conclusions, The study demonstrates that hypertension is a dramatic, unsolv ed problem in uraemic patients treated with peritoneal dialysis, and casts doubts on the effectiveness of our current peritoneal dialysis strategies a nd pharmacological management of hypertension.