Hypertension is a major cause of cardiovascular (CV) morbidity and mortality. Although
studies in the general population have demonstrated a continuous reduction in CV risk with
each mmHg drop in systolic blood pressure (SBP), multiple observational studies conducted in
hemodialysis (HD) patients have demonstrated that patients with mild to moderate hypertension
may have decreased mortality compared to those with normal blood pressure (BP). The
investigators recently reported that among HD patients, those with routine pre-dialysis BP
values that met the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines (<140/90 mm
Hg) had increased mortality compared to patients with mild to moderate hypertension. However,
these observational studies included untreated patients in whom low or normal BP may reflect
significant cardiac disease or other comorbid conditions. In the setting of reduced vascular
compliance and impaired autoregulation, aggressive BP lowering may decrease coronary or
cerebral perfusion. Thus, it is unclear if aggressive BP lowering will be harmful or
beneficial. A well-designed randomized control trial (RCT) is needed to answer this important
question. Prior to conducting a full-scale RCT it is prudent to conduct a pilot study to
assess feasibility and inform the design of the former. The investigators propose to conduct
a pilot RCT in a prevalent cohort of HD patients to assess the safety and feasibility of
treating patients to a low (110-140 mmHg)and standard (155-165) mm Hg pre-dialysis BP target.
Phase:
N/A
Details
Lead Sponsor:
University of New Mexico
Collaborators:
Case Western Reserve University Medical University of South Carolina The Cleveland Clinic Tufts Medical Center University of Pittsburgh