演題情報

学会・委員会企画

開催回
第56回・2011年・横浜
 

Blood Pressure Control and Survival of Dialysis Patients

演題番号 : GI-7-3

Kunitoshi Iseki:1

1:Dialysis Unit University Hospital of the Ryukyus

 

Hypertension is prevalent and it is difficult to control in chronic hemodialysis (HD) population. Thus, cardiovascular disease (CVD) remains the leading cause of death in this population. Available evidence, however, contradicts the guidelines for treating hypertension in non-HD patients. The prognosis is rather better for HD patients with hypertension than those with normal or low BP. On the other hand, in dialysis populations with a long and slow dialysis regimen, the prognosis is better for those with lower BP levels than for the majority of the dialysis population. A recent meta-analysis reported better survival among HD patients on antihypertensive medications regardless of their BP levels. We observed a similar phenomenon in a large cohort of Japanese dialysis patients. Antihypertensives, including renin-angiotensin system (RAS) inhibitors, are reported to effectively reduce cardiac morbidity and mortality among the non-HD population. Against these backgrounds, we are conducting a study to examine the effect of targeted control of hypertension and of the class of antihypertensive drugs among the HD population. The study hypothesis includes the following; 1) survival will improve if the pre-HD BP is controlled with a targeted level of less than 140/90 mm Hg, 2) the incidence of cardiovascular disease, both fatal and non-fatal, will decrease if pre-HD blood pressure is controlled to less than 140/90 mm Hg, 3) a treatment regimen with a RAS inhibitor (olmesartan) and conventional antihypertensives will improve morbidity and mortality compared to those treated with conventional drugs without RAS inhibitors, and 4) home BP may predict morbidity and mortality better than pre-HD BP. The study will end on June, 2011.

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