Management of hypertension for patients undergoing dialysis therapy

Abstract

Hypertension is very prevalent among patients undergoing dialysis therapy: hemodialysis (HD) and peritoneal dialysis (PD). Although it is recognized as a great risk of cardiovascular mortality for these populations, how to regulate blood pressure (BP) is poorly understood. For HD patients, we should pay much attention to methods of measuring BP. Outof-center BP levels and BP variability should be evaluated by ambulatory BP monitoring and home BP measurement because they are closely associated with cardiovascular mortality. Although target BP levels are not clear, several clinical guidelines suggest <140/90 mmHg. However, it must be determined for each individual patient with careful considerations about comorbidities. Based on the underling pathophysiology of hypertension in patients on dialysis, maintaining an appropriate volume of body fluid by dietary salt restriction and optimization of dry weigh should be considered as a first line therapy. Inhibitors for renin-angiotensin system may be suitable to reduce BP and mortality for those patients on dialysis. These drugs may also be effective for preserving residual renal function and peritoneal function for PD patients. β-blockers may have potentials to improve survival for HD patients and can be added to antihypertensive medications. Lacking large-scale and good quality clinical trials, there are many questions to be answered. Much effort should continuously be made to create evidences for better management of hypertension for patients on dialysis therapy.

Taking a Step Further in Identifying Ideal Blood Pressure Range Among Hemodialysis Patients: A Systematic Review and a Meta-Analysis

“…Several studies have shown a "U-shape" relationship between high blood pressure and mortality, implying that blood pressure levels below certain range is more harmful than higher levels (Carney, 2013). Hypertension being multifactorial in nature and this reverse epidemiology of blood pressure and mortality makes it difficult to determine blood pressure targets especially in highrisk patients such as ESRD patients on hemodialysis (Taniyama, 2016).…”

Office and 44-hour ambulatory blood pressure and central haemodynamic parameters in the patients with end-stage renal diseases undergoing haemodialysis

“…ст. -62 и 28 % соответственно [26,27]. Столь высокая частота неконтролируемой АГ у пациентов с ТПН объясняется гемодинамической перегрузкой, повышенной активностью РААС и симпатической нервной системы, гиперпаратиреозом и кальцификацией артерий [24].…”

The Impact of Hemodialysis Frequency and Duration on Blood Pressure Management and Quality of Life in End-Stage Renal Disease Patients

“…This means the removal of fluid during HD creates a less drastic fluid shift between the intracellular, interstitial, and extracellular space. Excessive salt and water play a critical role in raising the BP of HD patients [ 18 , 19 ]. Since cardiovascular complications are the major causes of mortality and morbidity in HD patients, salt and water can be considered as the most important “uremic toxins,” because their retention is of huge concern and has a great impact on the lives of patients.…”