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Hypertension in chronic hemodialysis patients: current view on pathophysiology and treatment
D Grekas1, G Bamichas, D Bacharaki
1First Medical Department, University Hospital AHEPA, Thessaloniki, Greece.
Insights
Hypertension is common in hemodialysis patients, with current treatments often ineffective. Further research is needed to understand and manage dialysis-induced hypertension.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Internal Medicine
Background:
- Hypertension affects a significant majority of patients initiating dialysis.
- Dialysis alone can manage hypertension in over half of affected patients.
Purpose of the Study:
- To survey the status of blood pressure (BP) control in hemodialysis patients.
- To identify factors associated with hypertension in this population.
Main Methods:
- A survey of 113 hemodialysis patients (66 male, 47 female) was conducted.
- Measurements included predialysis and post-dialysis mean arterial pressure (MAP), weight changes, fluid removal, and antihypertensive medication use.
Main Results:
- Hypertension prevalence was 59%, defined as pre-MAP > 110 mmHg.
- Excess volume and interdialytic weight gain correlated with pre-MAP (p=0.03).
- Patients on fewer antihypertensive drugs had lower pre-MAP, suggesting treatment resistance.
Conclusions:
- Current hemodialysis methods are insufficient for effective BP control.
- Further investigation into the roles of fluid overload and vasomotor systems in dialysis hypertension is necessary.
Background:
Hypertension accounts for 65 - 85% of patients beginning dialysis, and dialysis alone controls hypertension in over 50% of patients.
Patient And Methods:
We have surveyed the status of BP control in 113 hemodialysis patients, 66 men and 47 women, aged 59 +/- 13 years old, with a mean duration on hemodialysis 42 +/- 44 months. The following measurements were recorded: predialysis mean arterial pressure (pre-MAP), post-dialysis MAP (post-MAP), percentage of change in MAP, pre-dialysis weight, post-dialysis weight, fluid removed by ultrafiltration during each dialysis session, interdialytic weight gain and excess weight over the desirable dry weight.
Results:
Our results showed a hypertension prevalence of 59% (hypertension defined as pre-MAP +/- 110 mmHg). MAP was not different between men and women, and only 4.5% of patients had isolated systolic hypertension. All hypertensive patients were on treatment with antihypertensives. Reduction in post-MAP by > or = 5% (controlled by ultrafiltration) was found in 68.5% of hypertensive and in 87.5% of normotensive patients. Age, primary renal disease, time on dialysis and adequacy of dialysis were not correlated with pre-MAP. Excess volume and interdialytic weight gain were found to correlate with pre-MAP (p = 0.03). Also, the weekly dosage of EPO had a significant correlation with pre-MAP (p = 0.03). No differences were found among four classes of antihypertensive drugs regarding the BP control. Patients with hypertension requiring one drug achieved a significantly (p < 0.05) lower pre-MAP than the group of patients receiving three or more drugs. In conclusion, hemodialysis population shows high prevalence of hypertension, resistant to antihypertensive treatment.
Conclusion:
Current methods of hemodialysis are not effective in controlling BP. This implies that more insight into the role of excess volume and vasomotor systems in the pathogenesis of dialysis hypertension is warranted.