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논문분류	춘계학술대회 초록집
제목	Adequately Controlled Systolic Blood Pressure is Significantly Associated with Better Survival Rate, Irrespective of Number of Antihypertensive Agents in Prevalent Dialysis Patients
저자	Jong Hyun Jhee* 1, Su-Young Jung1, Seohyun Park1, Hyoungnae Kim1, Hae-Ryong Yun1, Youn Kyung Kee1, Chang-Yun Yoon1, Young Eun Kwon1, Jung Tak Park1, Seung Hyeok Han1, Yong-Lim Kim2, Yon Su Kim3, Shin-Wook Kang1, Chul Woo Yang4, Nam-Ho Kim5, Tae-Hyun Yoo1
출판정보	2016; 2016(1):
키워드	Antihypertensive agent, Blood pressure target, Dialysis, End-stage renal disease
초록	Background: Although hypertension (HTN) is a common clinical problem and contributes to high risk for adverse clinical outcomes in dialysis patients, the proper blood pressure (BP) target is still controversy. Strict BP control could result in lower rates of major cardiovascular events and all-cause mortality in general population. However, the reverse epidemiology phenomenon about target BP has been widely accepted in dialysis patients groups. The object of this study is to investigate optimal BP target and adequate management of BP in prevalent dialysis patients group. Methods: The data were retrieved from End-stage Renal Disease-Clinical Research Center (ESRD-CRC) which dialysis patients were prospectively enrolled from 2009 to 2014. Total 2,299 prevalent dialysis patients were analyzed. Eligible patients were assigned to four groups according to distribution of systolic BP (SBP, group as SBP <120, 120-140, 140-160, and >160 mmHg, respectively). The primary outcome was all-cause mortality. During a baseline study visit, classes of antihypertensive agent (AHA) being taken were determined by pill bottle inspection. Results: Among the study subjects, there were 360, 862, 719, and 358 patients in each SBP groups. The mean SBP in each group was 106.9, 128.6, 146.4 and 170.9 mmHg, respectively (P<0.001). Baseline characteristics among the groups did not show significant differences except number of AHAs (1.5±1.4, 1.8±1.5, 2.1±1.4, and 2.3±1.3 pills in each group, P<0.001). During a median follow up of 4.5 years, all-cause mortality was significantly higher in SBP <120 mmHg group (hazard ratio [HR] 1.44, confidence interval [CI] 1.06-1.94, P=0.019), while the tendency with higher risk was revealed in >160 mmHg group (HR 1.33, CI 0.94-1.81, P=0.074) compared to groups, whose BP ranged from 120 to 160 mmHg. Multiple Cox analysis revealed that SBP <120 and >160 mmHg group had significantly higher risk of all-cause mortality after adjustment for age, sex, history of diabetes and cardiovascular events, duration of dialysis, serum albumin, hemoglobin, sodium, parathyroid hormone, and high sensitivity C-reactive proteins (HR 1.84, CI 1.27-2.66, P=0.001; HR 1.69, CI 1.16-2.45, P=0.006). However, the number of AHAs being taken was not associated with survival rate in subgroup analysis with each BP group. Conclusion: This study showed that lowest (<120) or highest (>160 mmHg) SBP group had significantly higher risk of all-cause mortality, irrespective of number of AHAs. BP control with optimal target is significantly associated with better survival rate. Further study is warranted to determine optimal blood pressure target in dialysis patients.
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