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Objectives: We retrospectively assessed both blood pressure response to management in a specialist Hypertension Clinic and the predictors of response. Design: Retrospective data audit. Setting: Hypertension Clinic at Guy's and St Thomas' Hospitals, London, UK. Participants: One hundred and twenty-two sequential patients attending the clinic between January 2017 and October 2018. Patients were excluded if they had previously been seen in the clinic, failed to attend their initial appointment or did not return after their initial appointment. Outcome measure: Change in blood pressure readings between first and last recorded appointments. Results: Systolic blood pressure decreased from 149 ± 20 mmHg to 140 ± 17 mmHg, and diastolic blood pressure from 92 ± 13 to 86 ± 1 mmHg, between the first and last recorded appointments (P < 0.05 for each). Those patients who reached target blood pressure were significantly younger than those who did not (age 45 ± 14 versus 52 ± 17 years, P = 0.0171); however, the degree of blood pressure reduction was independent of age, and younger subjects had a baseline blood pressure significantly lower than older subjects. Sex, body mass index and lifestyle interventions had an important effect on blood pressure reduction; however, these were not associated with attainment of target blood pressure. Conclusion: Specialist hypertension input is effective in helping patients to achieve target blood pressure, especially so in younger as compared to older hypertensive patients, but this appears to be related to the fact that blood pressure in younger patients is already closer to target at baseline. Blood pressure reduction is greater in women, those with higher body mass index and those who receive lifestyle interventions. [ABSTRACT FROM AUTHOR]

Background:Cardiovascular disease remains the most common cause of mortality in end-stage kidney failure patients with diabetes. To improve blood pressure control, and reduce cardiovascular risk, in 2002 the UK Renal Association Standards’ Committee introduced pre- and post-dialysis target blood pressures of <140/90 and <130/80 mm Hg, respectively. Methods: We audited blood pressure control and symptomatic intradialytic hypotension during 1 week in the eleven renal centres in the Greater London Urban Area in 2,193 patients, capturing 6,579 haemodialysis sessions. Results: Although 73.9% of the 658 diabetic patients were prescribed antihypertensive medications, compared to 57.8% of the 1,535 non-diabetic patients (p < 0.001), both the mean pre- and post-dialysis blood pressures were greater in the diabetic patients: before dialysis 152 ± 23/77 ± 13 versus 144 ± 23/79 ± 13 mm Hg and after dialysis 138 ± 24/71 ± 12 versus 132 ± 26/73 ± 13 mm Hg, and fewer diabetic patients achieved the pre- and post-dialysis blood pressure targets: 28.6 versus 40.8% and 37.9 versus 46.3%, respectively (p < 0.01). In addition, more diabetic patients suffered symptomatic intradialytic hypotension, 20.3 versus 14.9% (p < 0.01), associated with greater interdialytic weight gains. Conclusion: Diabetic haemodialysis patients had higher blood pressures, both before and after dialysis, associated with greater interdialytic weight gains and more frequent symptomatic intradialytic hypotension. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]