Hypertension in Chronic Kidney Disease Part 1

The Impact of Antihypertensive Drug Therapy in Patients With Chronic Kidney Disease: A Prospective Observational Cohort Study

“…The predominance of the male in the study cohorts is similar to earlier studies [6,17]. The prevalence of hypertension gradually increases as renal function deteriorates, and a high BP condition is almost universal in patients who progress to ESRD [28]. In the present study, the majority of the population were receiving haemodialysis apart from antihypertensive therapy.…”

A Comparative Study of Short-Term Blood Pressure Variability in Hemodialysis Patients with and without Intradialytic Hypertension

“…Intradialytic hypertension is observed in approximately only 5-15% of hemodialysis patients [5,32], and has a rather complex pathophysiology [5], involving sympathetic nervous system (SNS) overdrive, excess renin-angiotensin-aldosterone-system (RAAS) activation stimulated by acute volume removal with the ultrafiltration, abnormal endothelial response leading to endothelin-1 production and nitric oxide decrease, intradialytic sodium gain, acute drop in dialyzable antihypertensive drugs levels during sessions, but also even inability to achieve optimal dry weight associated with chronic volume overload [5,33]. Our aim herein falls within a recently proposed rationale on the use of 44-h ABPM as the "gold-standard" method for the diagnosis of hypertension and follow-up of treatment in hemodialysis patients, not only due to the several established benefits of ABPM in the general population, but also due to the superior prognostic utility of ABPM in this patient group [2,9,34,35]. This is of particular importance, since previous cohort studies have shown that intradialytic hypertension is strongly associated with an increased risk of all-cause and cardiovascular mortality [6][7][8].…”

Hypertension in patients on dialysis: diagnosis, mechanisms, and management

“…Although BP is measured frequently in the dialysis treatment environment, aspects related to the measurement technique employed may be unsatisfactory. Several other tools are now available and being used in clinical trials and clinical practice to evaluate and treat elevated BP in chronic kidney disease (CKD) patients 1 , 2. Different levels of BP may be observed in the same patient under distinct situations, which include evaluations before, during, or after the dialysis session, and at home using ambulatory BP measurements (ABPM), being frequently and substantially lower than during dialysis measurements 3…”

“…The National Kidney Foundation - Kidney Diseases Outcomes Quality Initiative guideline established that hypertension in hemodialysis patients is diagnosed when pre-dialysis BP is > 140/90 mmHg or when post-dialysis BP is > 130/80 mmHg,24 but the conventional peridialytic BP recordings may not be accurate. Pre- and post-dialysis BPs measures are obtained by the staff of the dialysis unit, often without the necessary attention to the correct measurement technique 1 , 225…”

“…Additionally, home BP was shown to have high short-term reproducibility from one week to the next and it is strongly associated with indices of target organ damage, such as aortic stiffness and left ventricular hypertrophy (LVH) 29. Currently, many authors suggest that ambulatory BP monitoring (ABPM) may be the gold standard method for diagnosing hypertension in patients receiving dialysis 2. ), ( 12 Observational studies clearly suggest that ABPM predicts all-cause and cardiovascular mortality better than peri-dialytic BP 13.…”