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[Hypertension in hemodialyzed uremic patients]
D Sobotová1, A Zharfbin, J Svojanovský
1II. vnitrní klinika Fakultní nemocnice U sv. Anny, Brno.
Vnitrni Lekarstvi
|August 22, 2000
Summary
Hypertension in hemodialysis patients stems from multiple factors including fluid imbalance and hormonal changes. Optimal blood pressure management is crucial for survival, with specific targets needed for hemodialysis populations.
Area of Science:
- Nephrology and Hypertension
- Urology
- Internal Medicine
Context:
- Hypertension is a common and complex comorbidity in patients undergoing hemodialysis for end-stage renal disease.
- The pathogenesis involves impaired kidney function, overactive renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system, endothelin-1, and reduced nitric oxide (NO) synthesis.
- Additional contributing factors include hyperparathyroidism, arterial calcification, erythropoietin therapy, and pre-existing essential hypertension.
Purpose:
- To elucidate the multifactorial pathogenesis of hypertension in hemodialyzed uraemic patients.
- To outline current treatment strategies, encompassing dietary modifications, fluid management, and pharmacological interventions.
- To explore the complex relationship between blood pressure (BP) and survival in this patient population.
Summary:
- Hypertension in hemodialysis patients is driven by impaired sodium/water excretion, RAAS and sympathetic overactivity, elevated endothelin-1, reduced NO synthesis, and factors like hyperparathyroidism and arterial stiffness.
- Treatment involves strict salt restriction (<5 g/day), meticulous extracellular fluid volume control via ultrafiltration to dry weight, and judicious pharmacotherapy (beta-blockers, calcium channel blockers, ACE inhibitors, AT1 receptor inhibitors, alpha-blockers).
- The relationship between BP and survival is bimodal, with both high and low BP being detrimental. Mean arterial pressure (MAP) targets are suggested to minimize adverse cardiovascular events and improve long-term survival.
Impact:
- Establishes the multifactorial nature of hypertension in hemodialysis patients, guiding clinical understanding.
- Provides a comprehensive overview of current and potential therapeutic approaches, including pharmacological and non-pharmacological interventions.
- Highlights the critical, yet undefined, role of blood pressure targets in optimizing survival and reducing cardiovascular complications in hemodialyzed individuals.