Background: Despite the clinical importance of blood pressure control in patients undergoing hemodialysis (HD), evidence on the blood pressure ranges associated with favorable outcomes remains limited and inconsistent.
Methods: We retrospectively analyzed the data from the HD quality assessments in South Korea. Systolic blood pressure (SBP) was classified into 6 groups: VL-sys group (< 100, n = 230), L-sys (100-120, n = 2,272), R-sys (120-140, n = 17,004), H-sys (140-160, n = 17,493), VH-sys (160-180, n = 4,627), and EH-sys (≥ 180, n = 632). Diastolic blood pressure (DBP) was divided into 6 groups: EL-dia (< 60, n = 1,349), VL-dia (60-70, n = 5,460), L-dia (70-80, n = 13,361), R-dia (80-90, n = 17,442), H-dia (90-100, n = 4,211), and VH-dia (≥ 100, n = 435). Outcomes include all-cause mortality, cardiovascular events (CVE), dementia, atrial fibrillation (Afib), and fracture risk.
Results: Higher SBP was associated with increased risks of all-cause mortality, CVE, dementia, and fractures compared to those of the R-sys group. Conversely, lower SBP was associated with reduced risks for all-cause mortality and CVE. The L-sys group had an adjusted hazard ratio of 0.92 (95% confidence interval [CI], 0.86-0.99) for all-cause mortality and 0.84 (95% CI, 0.76-0.93) for CVE compared with the R-sys group. Regarding DBP, in univariable analysis, survival rate was higher in the VH-dia group compared to R-dia group, but contradictive results were shown in multivariable analysis. Overall, in multivariable analysis, higher levels were associated with increased risks of all-cause mortality, CVE, and dementia, while lower DBP, particularly in the VL-dia and L-dia groups, was associated with reduced risks.
Conclusions: In our study, a SBP of 100-119 mmHg and a DBP of 60-79 mmHg were associated with improved overall survival, reduced incidence of CVE, and lower risk of dementia and fractures in patients undergoing HD.
Keywords: Blood pressure; Cardiovascular disease; Hemodialysis; Mortality.
© 2026. The Author(s).