The following is the summary of “Clinical characteristics and management of hemodialysis patients with pre-dialysis hypertension: a multicenter observational study” published in the October 2022 issue of Renal failure by Liang, et al.

Hemodialysis patients’ high blood pressure is an avoidable contributor to cardiovascular disease. Increased risk of cardiovascular events and overall mortality was previously ascribed to pre-dialysis systolic blood pressure (SBP) of more than 160 mmHg. The current study aimed to understand better the clinical profile and treatment options for hemodialysis patients with systolic blood pressure (SBP) below 160 mmHg prior to dialysis.

A total of 1,233 hemodialysis patients from 9 facilities participated. Clinical data, such as blood pressure readings taken before dialysis and at home, were gathered. Patients having a pre-dialysis systolic blood pressure (SBP) of 160 mmHg or less were analyzed to learn more about this population. Hypertensive patients and healthy controls had their clinical measures compared. The connections between BP and clinical indicators were determined by doing a partial correlation analysis. Pre-dialysis blood pressure was below ≥160 mmHg in 24.6% of hemodialysis patients, with a mean of 173.8 ± 10.9mmHg (standard deviation = 11.9). After dialysis, only 21.4% of patients reached their target dry weight, and up to 30.2% were not prescribed antihypertensive medication combinations. Patients with pre-hemodialysis systolic blood pressure (SBP)>160 mmHg were more likely to experience intradialytic hypotension and muscle spasm, and their Kt/v target-reaching rate was lower. On average, patients with a pre-dialysis SBP≥160 mmHg had an SBP≥135 mmHg at home (96%). 

Left ventricular weight index and hemoglobin levels were both greater in patients whose home SBP≥160 mmHg than in those whose home SBP was above (<160 mmHg). Most individuals might be classified as hypertensive based on their home systolic blood pressure readings before beginning dialysis. Patients with systolic blood pressure (SBP) below 160 mmHg prior to dialysis are at increased risk for dialysis insufficiency and intradialytic complications. To better regulate blood pressure in the hemodialysis population, efforts should be increased toward achieving dry weight and adequate pharmacologic therapies.