Debate from the 2012 ASH Annual Scientific Sessions: should blood pressure be reduced in hemodialysis patients? Con position.

The relationship between blood pressure and cardiovascular events in hemodialysis patients is complicated and controversial. The timing of blood pressure measurements (home, before dialysis, after dialysis, during dialysis) provide somewhat different results. Moreover, the use of antihypertensive medications may also confound the relationship between blood pressure and cardiovascular outcome. Most important may be the relationship between central blood volume/pressure and risk for cardiac events, specifically for congestive heart failure and sudden death. Achieving dry-weight during dialysis as opposed to a specific blood pressure level is the optimal strategy for reducing cardiovascular events in the hemodialysis patient.