Hypertension is common and contributes to adverse outcomes in patients undergoing dialysis. However, the proper blood pressure (BP) target remains controversial and several factors make this difficult. This study aimed to investigate the adequate BP target in patients undergoing prevalent dialysis. Data were retrieved from the Clinical Research Center for End-Stage Renal Disease (2009–2014). 2,299 patients undergoing dialysis were evaluated. Patients were assigned into eight groups according to predialysis systolic blood pressure (SBP). The primary outcome was all-cause mortality. During the median follow-up of 4.5 years, a U-shape relation between SBP and mortality was found. The risk of mortality was increased in the SBP <110 and ≥170 mmHg groups. In subgroup analysis, the risk of mortality was similarly shown U-shape with SBP in subjects with no comorbidities, and no use of antihypertensive agents. However, only lowest SBP was a risk factor for mortality in patients with older, having diabetes or coronary artery disease, whereas highest SBP was an only risk factor in younger patients. In respect of dialysis characteristics, patients undergoing hemodialysis showed U-shape between SBP and mortality, while patients undergoing peritoneal dialysis did not. Among hemodialysis patients, patients with shorter dialysis vintage and less interdialytic weight gain showed U-shape association between SBP and mortality. This study showed that the lowest or highest SBP group had higher risk of mortality. Nevertheless, the optimal target BP should be applied according to individual condition of each patient.
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We express our gratitude to all the investigators of CRC-ESRD in Korea. The members of the CRC-ESRD are: Do J.Y. at Yeungnam University Medical Center; Song S.H. at Pusan National University Hospital; Kim S.E. at Dong-a University Medical Center; Kim S.H. at Daegu Fatima Hospital; Kim Y.H. at Inje University Paik Hospital; Lee J.S. at Ulsan University Hospital; Jin H.J. at Seoul National University Bundang Hospital; Lim C.S. and Lee J.P. at Seoul National University Boramae Medical Center; Chang J.H. at Gachon University Gil Medical Center; Park H.C. at Yonsei University Gangnam Severance Hospital; Chang T.I. at National Health Insurance Corporation Ilsan Hospital; Ryu D.R. and Oh H.J. at Ehwa Womens University Mokdong Hospital; Oh D.J. at Kwandong University Myongji Hospital; Chang Y.S. at The Catholic University of Korea St. Mary’s Hospital; Kim Y.O. at The Catholic University of Korea Uijeongbu St. Mary’s Hospital; Kim S.H. at Chung-Ang University Medical Center; Jin D.C. at The Catholic University of Korea St. Vincent’s Hospital; Kim Y.K. at The Catholic University of Korea, Bucheon St. Mary’s Hospital; Kim H. Y. at Chungbuk National University Hospital; Kim W. at Chonbuk National University Hospital; Lee K.W. at Chungnam National University Hospital; and Lee C.S. at Cheju Halla General Hospital. This work was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC15C1129). This study was also supported by a research grant from Inha University Hospital.
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