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Iseki K, Fukiyama K
Predictors of stroke in patients receiving chronic hemodialysis
Kidney Int (Nov) 50:1672-1675 1996
Hypertension increases the risk of stroke, other cardiovascular events, and mortality in non- dialysis patients. Despite this, the USRDS has been unable to show a correlation between high blood pressure and death in a number of its analyses, an observation which is definitely not politically correct and remains unexplained.
In the present paper, Iseki and Fukiyama examined the incidence of ischemic and hemorrhagic stroke in 1243 Japanese patients on hemodialysis, incident before 1990 and prevalent as of January, 1991. Over a 5 year follow up period, 90 cases of stroke were observed, of which 78% were hemorrhagic (70% cerebral, 8% subarachnoid), and 22% ischemic. Hypertension was defined on the basis of a predialysis reading taken on January 1. Patients with diastolic BP > 90 mm Hg or a systolic > 140 mm Hg were defined as having hypertension. The average age of the patients was 53 years, and the prevalence of diabetes was about 18%. Overall five-year survival was 72%!
Using logistic multiple regression, initial hypertension was a predictor of stroke, with an odds ratio of 2.4. With regard to systolic BP, the risk of both hemorrhagic and ischemic stroke increased progressively in groups < 140, 140-159, and > 160 mm Hg. With regard to diastolic BP, risk increased at a cut-off of about 80 mm Hg, and was not higher when patients with diastolic BP > 90 mm Hg were compared to those with pressures of 80-89 mm Hg.
Comment: The data are reassuring to all of us who realize that, despite some analyses to the contrary, high BP must be deleterious to dialysis patients. (John T. Daugirdas, M.D., University of Illinois at Chicago)
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