Strict Blood Pressure Control Is Associated with Better Survival in Korean Patients on Hemodialysis, but Not in Patients on Peritonal Dialysis

Background: Adequate blood pressure (BP) control is considered one of main treatment strategies in dialysis patients. However, the goal and ideal range of BP have not been defined exactly among dialysis patients. We aimed to investigate proper management for BP control associated with better survival in dialysis patients. Methods: Based on the data of health screening results from 2002 to 2018 in the database of the Korean National Health Insurance System (NHIS), we examined the association of BP control with all-cause and cardiovascular mortality among hemodialysis (HD) and peritoneal dialysis (PD) patients using Cox-regression analysis. Results: A total of 46,649 patients (39,472 HD and 6,177 PD) were enrolled for the analysis. The mean systolic blood pressure (SBP) was 134.4mmHg and 133.8mmHg in HD and PD patients, respectively. A comparable proportion of HD and PD patients was distributed in each SBP category. In this analysis, the reference SBP group was set as 120-140mmHg. In the HD group, the all-cause mortality increased as SBP was managed higher than 140. The mortality risk was also greater when SBP was lower than 120. As well in PD patients, the all-cause mortality risk increased when SBPs were managed below 120mmHg; however, higher systolic BPs in PD patients were not significantly associated with higher mortality. Managing systolic BP above 160mmHg in HD patients showed greater cardiovascular mortality whereas, higher blood pressure was not evidently associated with cardiovascular mortality in PD patients. Conclusion: Blood pressure should be managed strictly as systolic blood pressure lower than 120mmHg or greater than 140mmHg is associated with higher mortality in Korean hemodialysis patients. Additional research is needed concerning peritoneal dialysis patients, as the impact of the ideal systolic blood pressure target differs from that observed in hemodialysis patients.Table 1. All-cause and Cardiovascular Mortality in PD and HD Patients