ROLE OF SYSTOLIC BLOOD-PRESSURE IN DETERMINING PROGNOSIS OF HEMODIALYZED PATIENTS

The role of blood pressure in determining the prognosis of hemodialyzed patients was examined in 195 patients who were introduced to hemodialysis, The relationship between blood pressure and survival or death was analyzed. In 46 patients who died within 3 years after the introduction of hemodialysis (nonsurvivors), the age was higher (61 +/- 2 years v 50 +/- 1 years), the occurrence of diabetic nephropathy was higher, and the systolic pressure was higher in both the introduction (178 +/- 4 mm Hg v 167 +/- 2 mm Hg) and maintenance (165 +/- 4 mm Hg v 147 +/- 2 mm Hg) phases than in 132 patients who survived more than 3 years (survivors). On the other hand, there were no significant differences in diastolic pressure during either phase between the two groups of patients, When diabetic nephropathy was excluded, only systolic pressure during the maintenance phase was higher in the nonsurvivors than in the survivors, Therefore, based on systolic pressure during the maintenance phase, patients were divided into two groups, the HT group (greater than or equal to 160 mm Hg) and the NT group (<160 mm Hg), and cumulative survival rates were compared, Whether all patients, only those patients with diabetic nephropathy, or only those patients without diabetic nephropathy were examined, the survival rate was higher in the NT group than in the HT group, Furthermore, patients were divided into the following three groups based on the changes in systolic pressure between the introduction of hemodialysis and the maintenance phase: the HT-NT group, whose systolic pressure was higher than 160 mm Hg during the introduction phase but decreased to below 160 mm Hg during the maintenance phase; the HT-HT group, whose pressure was higher than 160 mm Hg during both phases; and the NT-NT group, whose pressure was below 160 mm Hg during both phases, The cumulative survival rate in the HT-NT group was significantly higher than in the HT-HT group, being as high as that in the NT-NT group, Our results suggest that systolic pressure during the maintenance phase, corrected by hemodialysis, plays an important role in determining the prognosis of hemodialyzed patients. (C) 1995 by the National Kidney Foundation, Inc.