Can antihypertensive medications control BP in haemodialysis patients: yes or no?
1999; Oxford University Press; Volume: 14; Issue: 11 Linguagem: Inglês
10.1093/ndt/14.11.2599
ISSN1460-2385
Autores Tópico(s)Health Systems, Economic Evaluations, Quality of Life
Resumohaemodialysis centres. One is located in Nottingham, UK, the other in Tassin, France. This comparison clearly demonstrates that patient survival is much better in the French dialysis unit than in the dialysis unit in England. After careful analysis of all relevant risk factors such as age and comorbidity, the authors conclude that the main identifiable factor, which could explain this difference in survival, is a marked difference in blood pressure among the patients from each unit. In Nottingham, most patients had chronic hypertension; in Tassin, which uses the drug free dry weight method of BP control [8], BP of almost all their patients was in the low normal range. This important comparison of survival results between Nottingham and Tassin also is of great interest because of the type of patients that did not show a difference in survival. These groups included diabetics and patients who began dialysis with severe cardiovascular co-morbidity. One would not expect control of BP to significantly prolong life in these groups because they already have advanced atherosclerosis and do not survive long enough to give BP control a chance to stabilize or perhaps reverse this condition. In the Belding H. Scribner born January 18, 1921. Framingham study [9], it took a minimum of 10 years for the benefits of normalizing BP to show an effect In the April 1999 issue of Nephrology Dialysis on patient survival. Thus, conclusions from papers like Transplantation, there is an article which summarizes that of Zager et al. [10] are misleading. These authors, the report of the US task force convened to study the based on a 2.5-year study, concluded that: ‘Establishing epidemic of cardiovascular disease in the haemodialysis optimal BP targets in patients will require a multipopulation [1]. This task force, composed of prestigicentre randomized controlled clinical trial that includes ous experts, collectively made a report on what to do serial electrocardiograms, 48 h APBM’s and informaabout the growing epidemic of cardiovascular disease tion on antihypertensive medications’. Such a concluin the haemodialysis population. On page 832, in the sion is unwarranted when one considers the mountain all important ‘treatment of hypertension’ section, this of evidence that supports the proposition that longsummary article contains the following statement: ‘All term control of hypertension uniformly helps to preclasses of anti-hypertensive agents are effective with vent the development of atherosclerosis. the exception of diuretics’. If that statement is true, However, in some dialysis patients with a life expecthow come greater than 65% of the world’s haemodiaancy of less than 5 years due to age and/or comorbidity, lysis patients are hypertensive [2–6 ]? aggressive treatment to try and control BP may represIn this same April 1999 issue, beginning on page ent a distraction and perhaps even be harmful. This 919 is a report of a study by Innes et al. [7]. This idea is supported by a recent study of Port et al. [11] study compares the mortality between two top quality and editorial comments by Salem [12]. In Port’s study, a low (<110 mmHg) pre-dialysis systolic BP was a Correspondence and offprint requests to: Belding H. Scribner MD, 3110 H. Portage Bay Place East, Seattle, WA 98102, USA. significant risk factor. According to the authors, this
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