Reverse Epidemiology of Hypertension and Cardiovascular Death in the Hemodialysis Population: The 58th Annual Fall Conference and Scientific Sessions

Maintenance hemodialysis patients in the United States have a high prevalence (≈80%) of systolic hypertension and a high mortality (≈20% per year). Some reports indicate a paradoxical association between hypertension and morality in hemodialysis patients (ie, a normal to low blood pressure is associ...

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Published in:Hypertension (Dallas, Tex. 1979) Tex. 1979), 2005-04, Vol.45 (4, Part 2 Suppl), p.811-817
Main Authors: Kalantar-Zadeh, Kamyar, Kilpatrick, Ryan D, McAllister, Charles J, Greenland, Sander, Kopple, Joel D
Format: Article
Language:English
Subjects:
Aged
Blood Pressure
Cardiovascular Diseases - etiology
Cardiovascular Diseases - mortality
Cohort Studies
Databases, Factual
Female
Humans
Hypertension - complications
Hypertension - physiopathology
Inflammation - complications
Male
Middle Aged
Predictive Value of Tests
Protein-Energy Malnutrition - complications
Renal Dialysis - mortality
Survival Analysis
Syndrome
United States - epidemiology
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Summary:Maintenance hemodialysis patients in the United States have a high prevalence (≈80%) of systolic hypertension and a high mortality (≈20% per year). Some reports indicate a paradoxical association between hypertension and morality in hemodialysis patients (ie, a normal to low blood pressure is associated with poor outcome), whereas high pressure confers survival advantages, a phenomenon referred to as “reverse epidemiology.” We hypothesized that malnutrition-inflammation complex syndrome may be a cause of this paradoxical association. We studied a 15-month cohort of 40 933 hemodialysis patients in the United States whose predialysis and postdialysis blood pressure values were recorded routinely during each hemodialysis treatment. Patients were 59.8±15.3 years old; 54% were women and 46% diabetics. Cox proportional hazard models were used for blood pressure categories (systolic
ISSN:0194-911X
1524-4563
DOI:10.1161/01.HYP.0000154895.18269.67