Abstract
BACKGROUND AND OBJECTIVES: Increasing BP during maintenance hemodialysis or intradialytic hypertension is associated with increased morbidity and mortality. In hemodialysis patients, ambulatory BP measurements predict adverse cardiovascular outcomes better than in-center measurements. We hypothesized that patients with intradialytic hypertension have higher interdialytic ambulatory systolic BP than those without intradialytic hypertension. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a case-control study in adult hemodialysis patients. Cases consisted of subjects with intradialytic-hypertension (systolic BP increase ≥10 mmHg from pre- to posthemodialysis in at least four of six treatments), and controls were subjects with ≥10 mmHg decreases from pre- to posthemodialysis in at least four of six treatments. The primary outcome was mean interdialytic 44-hour systolic ambulatory BP. RESULTS: Fifty subjects with a mean age of 54.5 years were enrolled (25 per group) among whom 80% were men, 86% diabetic, 62% Hispanic, and 38% African American. The mean prehemodialysis systolic BP for the intradialytic-hypertension and control groups were 144.0 and 155.5 mmHg, respectively. Mean posthemodialysis systolic BP was 159.0 and 128.1 mmHg, for the intradialytic-hypertension and control groups, respectively. The mean systolic ambulatory BP was 155.4 and 142.4 mmHg for the intradialytic-hypertension and control groups, respectively (P = 0.005). Both daytime and nocturnal systolic BP were higher among those with intradialytic hypertension as compared with controls. There was no difference in interdialytic weight gain between groups. CONCLUSIONS: Time-integrated BP burden as measured by 44-hour ambulatory BP is higher in hemodialysis patients with intradialytic hypertension than those without intradialytic hypertension.