Effect of Recombinant Human Erythropoietin Therapy on Ambulatory Blood Pressure and Heart Rate in Chronic Haemodialysis Patients.

Systemic hypertension as assessed by casual blood pressure measurements is a frequently reported side-effect of recombinant human erythropoietin (rHuEpo) treatment. We investigated the effect of rHuEpo treatment on the 24-h ambulatory blood pressure and heart rate profiles of 13 chronic haemodialysis patients. After 3–4 months of rHuEpo therapy it was found that the mean haematocrit had increased from 24.5± 1.0% to 32.0± 1.1% (<0.005), while body-weight and control of uraemia as assessed by routine laboratory data remained unchanged. Despite gradual and incomplete correction of anaemia by use of low doses of rHuEpo, increases in the ambulatory systolic and diastolic blood pressure were found. The greatest increases affected day-time systolic blood pressure and night-time diastolic blood pressure, and these increases were significant (<0.05). As a result, pulse pressure increased during day-time (<0.05) while the nighttime decline in diastolic blood pressure disappeared. An increase in peripheral resistance after partial correction of renal anaemia might explain these observations. rHuEpo therapy increased the percentage of abnormal ambulatory blood pressure measurements (defined as systolic blood pressure>140 mmHg and/or diastolic blood pressure >90 mmHg) from 33% to 52% (P<0.05) while in contrast, mean casual prehaemodialytic and posthaemodialytic blood pressure values remained unchanged. We conclude that changes in 24-h blood pressure profiles should be carefully assessed by ambulatory blood pressure monitoring in haemodialysis patients treated with rHuEpo, since these changes are likely to be missed when only causal blood pressures are measured. [ABSTRACT FROM PUBLISHER]