A Multicenter Investigation Of Hypertension Treatment And Control In Patients With Maintenance Dialysis

OBJECTIVES:Hypertension is still a challenge for the treatment of maintenance dialysis patients and its prevalence is higher than general population. The epidemiologic study of ESRD patients in our country is still at the beginning stage.This cross-sectional study focus on prevalence,treatment and control of hypertension in patients with maintenance dialysis.The study also analyzes the influencing factor of hypertension control in maintenance dialysis patients.METHODS:We studied the current status of 1650 patients with maintenance dialysis in 12 dialysis centers in Shanghai.852 patients were male,and 659 patients were female.1382 patients on hemodialysis and 268 patients who were treated with peritoneal dialysis were included in the study.Hypertension was defined as SBP≥140 and/or DBP≥90 mmHg.Those who had a history of hypertension and requiring antihypertensive therapy were also diagnosed as hypertension though their blood pressure within normal range.The purpose of hypertension control was to lower blood pressure to a target level.RESULTS:The prevalence of hypertension in the total group of dialysis patients was 84.8%.The prevalence of hypertension in hemodialysis patients was higher than those with peritoneal dialysis(86.3%v.s 77.2%,P＜0.001).The treatment of hypertension was 93.9%,which in hemodialysis patients was also higher than peritoneal dialysis patients(96.7%v.s 79.7%,P＜0.01).The percentage of dialysis patients with BP＜140/90mmHg was 27.1%,and there was no significant difference between hemodialysis patients and peritoneal dialysis patients(27.1%v.s.33.5%, P＞0.05).Most patients were treated with 1 medicine(53.1%),and calcium channel blocker(CCB) was the most frequently prescribed drug(61.1%of the patients accepted treatment),followed by AngiotensinⅡReceptor Blockers(47.2%), Centrally acting hypotensive agent(25.0%).There were significant differences between controlled group(blood pressure was controlled under 140/90mmHg ) and uncontrolled group(blood pressure≥140/90mmHg),such as the use of erythropoietin,the existence of coronary artery disease or the ST change in electrocardiogram,the numbers of antihypertensive agents and the hemodialysis regimen.Multivariable analyses indicated that the influencing factors for the unsatisfactory control of hypertension were different dialysis regimen.Conclusion:Unsatisfactory control of hypertension in maintenance dialysis patients is still a clinical challenge.Appropriate dialysis regimen,reasonable use of erythropoietin,treatment of heart disease and judicious use of antihypertensive drugs may be helpful to improve this clinical problem.