Mechanism and Treatment of Intradialytic Hypertension

1. To determine in a cross sectional case-controlled cohort study of 50 hemodialysis
patients if blood pressure elevations with hemodialysis are associated with increased
vascular stiffness (measured by pulse wave velocity) and/or decreased endothelial cell
function (measured by brachial artery flow mediated dilation and endothelial progenitor
cell number), both of which are novel mechanistic markers in the causal pathway for
detrimental cardiovascular outcomes; and

2. To determine if lowering blood pressure with carvedilol in 25 ESRD subjects with blood
pressure elevations with hemodialysis can improve vascular stiffness and/or endothelial
cell dysfunction as surrogate mechanistic markers for improving cardiovascular
outcomes.