The association of home blood pressure with all‐cause mortality in hemodialysis patients: A prospective observational study

Introduction Prior observational studies conducted in the hemodialysis population have suggested a reverse association between dialysis‐unit blood pressure (BP) and mortality. The present study aimed to investigate the prognostic association of home versus dialysis‐unit BP with all‐cause mortality in hemodialysis patients. Methods At baseline, 146 patients receiving maintenance hemodialysis underwent assessment of their BP with the following methods: (i) 2‐week averaged routine predialysis and postdialysis BP measurements; (ii) home BP monitoring for 1 week that included duplicate morning and evening BP measurements with the use of validated devices. Results Over a median follow‐up period of 38 months (interquartile range [IQR]: 22–54), 44 patients (31.1%) died. In Kaplan–Meier curves, predialysis and postdialysis systolic BP (SBP) was not associated with all‐cause mortality, while home SBP appeared to be of prognostic significance (log rank p = 0.029). After stratifying patients into quartiles, all‐cause mortality was lowest when home SBP was ranging from 128.1 to 136.8 mmHg (quartile 2). In univariate Cox regression analysis, using quartile 2 as a referent category, the risk of all‐cause mortality was 3.32‐fold higher in quartile 1, 1.53‐fold higher in quartile 3 and 3.25‐fold higher in quartile 4. The risk‐association remained unchanged after adjustment for several confounding factors (adjusted hazard ratio: 4.79, 1.79, 3.63 for quartiles 1, 3, and 4 of home systolic BP, respectively). Conclusion Our findings suggest that among hemodialysis patients, 1‐week averaged home SBP is independently associated with all‐cause mortality. In sharp contrast, SBP recorded either before or after dialysis over 2 weeks is not prognostically informative.