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120 no H o 90 so 6 80 S 70 60 50 12 3 4 5 min PLACEBO Dear Sir, The development of hypertension in 20-30% of hemodialysis patients receiving recombinant human erythropoietin (rHuEPO) remains an important side effect often requiring antihypertensive treatment [1-5]. The factors involved in the occurrence or aggravation of high blood pressure with rHuEPO are still matter of controversy. A first explanation is provided by the constant increase in total peripheral resistance secondary to both the rise in hematocrit (and hence blood viscosity) and to the correction of tissue hypoxia. However, our recent findings in rats show that rHuEPO-generated blood pressure elevation cannot be attributed solely to increases in blood viscosity and hemoglobin concentration [6]. It has also been suggested that the pressor effect of rHuEPO may be explained by action of the hormone on vascular smooth muscle, either directly [7] or via an activation of the tissue renin-angiotensin system [8]. Finally, rHuEPO could also induce hypertension by acting on the vascular endo-thelium [9-12]. Because, in a recent preliminary report, a direct blood pressure-raising effect of rHuEPO has been claimed [11], we decided to reexamine this question in 10 chronic hemodialysis patients in our dialysis facility (4 females, 6 males; mean age 47 years, range 20-81 years). The duration of their intermittent hemodialysis treatment was 28.2 months (range 3-120 months). Patients had the usual distribution of nephropathies, with 1 patient having non-insulin-dependent diabetes. Six of the ten patients received antihypertensive therapy (ACE inhibitors in 3 patients, calcium channel-blocking agents in 4, and ß-

Does Intravenous Erythropoietin Lead to an Immediate, Transient Increase in Arterial Blood Pressure in Dialysis Patients?