Blood Pressure in Dialysis Patients
The Cleveland Clinic
Medical University of South Carolina

      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.
    
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