Blood pressure in hemodiaylsis patients during amelioration of anemia with erythropoietin

Abstract

This study analyzed blood pressure in hemodialysis patients treated with epoetin beta in multicenter trials. Antihypertensive drugs were prescribed as usual. Placebo-controlled trials compared epoetin (100 to 150 U/kg; N = 151) with placebo (N = 78) for 82 days. Hemoglobin (108 ± 18 versus 75+14 g/L) (mean ± SD) and diastolic blood pressure (84 ± 14 versus 78 ± 15 mm Hg) were greater (P < 0.05) after epoetin. Clinically important increases in blood pressure (increases in diastolic blood presure ≥10 mm Hg and/or drug therapy) were more frequent with epoetin (58 versus 37%; P= 0.005). A dose-response trial compared epoetin, 25 U/kg (N = 42), 100 U/kg (N = 40), and 200 U/kg (N = 39) for 138 days. Increases in hemoglobin were dose dependent, but clinically important increases in blood pressure were not. In analyses of all patients treated with epoetin (N = 272), no baseline or final level of hemoglobin, or rate of hemoglobin rise, was a threshold for a rise in blood pressure. Patients requiring antihypertensive drugs or having uncontrolled hypertension (diastolic blood pressure >90 mm Hg) at baseline had decreases in blood pressure (P < 0.05) with antihypertensive therapy. Thus, compared with placebo, 21% of patients had clinically important increases in blood pressure during amelioration of anemia. The baseline or final levels of hemoglobin, the extent or rate of hemoglobin rise, or uncontrolled hypertension or antihypertensive drug use at baseline were not confirmed as risks. Antihypertensive drug therapy was important for blood pressure control.