Abstract: Objective Hypertension is still a challenge for the treatment of maintenance hemodialysis patients. The present study was designed to retrospectively investigate the treatment status for hypertension in these patients in Nanjing area. Methods Two hundred and ninety-seven maintenance hemodialysis patients with hypertension from 5 hemodialysis centers in Nanjing area were involved. Logistic regression model was used to analyze the correlation of hypertension to demographic variables, duration of dialysis, dosage of dialysis per week, antihypertensive therapy, physical examination, and laboratory variables. Blood pressure (BP) measurements were obtained before and after each dialysis. Results ① BP was unsatisfactorily controlled in 74.4% of the 297 patients (pre- and/or post-dialysis BP ≥140/90mmHg). Antihypertensives were prescribed for 242 patients (81.5%). Among them 37.6% patients were treated with single drug, and 62.4% with two or more than two drugs. Calcium channel blockers were prescribed to 85.1% of the patients. β-adrenergic receptor blockers, angiotensin II converting enzyme inhibitors (ACEIs), angiotensin II blockers (ARBs) were prescribed to 44.6%, 20.7%, 16.5% of the patients, respectively. The average number of prescribed antihypertensives was 1.54. ② Systolic hypertension without diastolic hypertension (≥140/<90mmHg) was found in most of the uncontrolled hypertensive patients, accounting for 63.9% and 72.0% of the patients in the pre- and post-dialysis periods, respectively. Diastolic hypertension without systolic hypertension (＜140/>90mmHg) only occurred in 2.1% and 6.9% of the pre- and post-dialysis patients, respectively. ③ The number of antihypertensives used was negatively correlated with the hemoglobin concentration (r=-0.250, P=0.001). ④ Multivariable analyses indicated that the risk factors for the unsatisfactory control of hypertension were inadequate dialysis (Kt/V＜1.4) (OR=5.308, 95% CI=1.608-17.560) and hypohemoglobinemia (OR=0.956, 95% CI = 0.914 - 0.999) in the pre-dialysis period, and moderate and severe anemia (OR=2.493, 95% CI=1.085-5.728) in the post-dialysis period. Conclusion Unsatisfactory control of hypertension predominately manifested by systolic hypertension in maintenance hemodialysis patients is still a clinical challenge. Appropriate dialysis, treatment of anemia and judicious use of antihypertensives may be helpful to improve this clinical problem.

Key words: Hypertension, Anemia, Dialysis adequacy