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Arterial hypertension and left ventricular hypertrophy in hemodialysis patients
1Division of Nephrology and Dialysis, Hospital of San Martino, Genova, Italy. ernesto.paoletti@hsanmartino.liguria.it
Insights
Left ventricular hypertrophy (LVH) in hemodialysis patients is often linked to uncontrolled arterial hypertension (AH). Strict blood pressure control, anemia management, and dialysis optimization can reverse LVH, with ACE inhibitors showing promise.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Management
Background:
- Left ventricular hypertrophy (LVH) is highly prevalent in hemodialysis (HD) patients.
- Arterial hypertension (AH) is often inadequately controlled in this population, partly due to unreliable clinical blood pressure (BP) readings.
- BP reduction from dialysis ultrafiltration is not a sufficient reason to stop antihypertensive therapy, especially with coexisting LVH.
Purpose of the Study:
- To highlight the challenges in diagnosing and treating AH in HD patients.
- To emphasize the importance of strict BP control for LVH regression in HD patients.
- To recommend diagnostic and monitoring tools for AH in HD patients with LVH.
Main Methods:
- Review of interventional studies on BP control, anemia correction, and dialysis adequacy.
- Analysis of factors predicting LVH regression, including systolic blood pressure (SBP) reduction and ACE-inhibitor therapy.
- Evaluation of the utility of Ambulatory Blood Pressure Monitoring (ABPM) and echocardiography.
Main Results:
- Strict BP control, anemia correction, and improved dialysis adequacy can lead to significant LVH regression.
- SBP reduction, particularly with ACE inhibitors, is a key predictor of LVH regression.
- ABPM and echocardiography are recommended for accurate AH detection and therapy monitoring.
Conclusions:
- Effective management of AH, anemia, and dialysis adequacy is crucial for reversing LVH in hemodialysis patients.
- Targeted antihypertensive therapy, including ACE inhibitors, plays a vital role in LVH regression.
- Utilizing ABPM and echocardiography ensures accurate diagnosis and effective management of AH in this vulnerable population.
Abstract:
The high prevalence of left ventricular hypertrophy (LVH) among hemodialysis patients may be a consequence of inadequate diagnosis and treatment of arterial hypertension (AH). AH is not adaquately controlled in hemodialysis patients probably due to an underestimation of the effective BP load due to the unreliability of clinical BP readings in this population. Furthermore, BP reduction induced by dialysis ultrafiltration is not an acceptable criterion for discontinuing antihypertensive therapy, particularly when LVH coexists. Indeed, the few available interventional studies have demonstrated that strict BP control, together with anemia correction and dialysis adequacy improvement, can induce significant regression of the LVH of hemodialysis patients. Moreover, the decrease of SBP, particularly as a result of ACE-inhibitor therapy, is the most important predictor of LVH regression. Finally the use of ABPM and of echocardiography are recommended for correctly detecting an underlying AH and for tailoring and monitoring the effectiveness of antihypertensive therapy in dialysis patients with LVH.