[Regulation of blood pressure in dialyzed patients]

Up to 90% of chronic haemodialysis patients have blood preasure (BP) greater than 140/90 mmHg. This suggests that only a minor number of the haemodialysis patients have adequate BP control. This is associated with significantly increased morbidity and mortality in haemodialysis population when compared with normal, healthy population. The main aim of antihypertensive treatment in hypertensive haemodialysis patients is to achieve BP values which should not differ from those recommended for general population. The most important factor in BP regulation in haemodialysis patients is adequate fluid volume regulation. Sympathetic nervous system and impaired vasodilatation with consequent changes in peripheral vascular resistance, secondary hyperparathyreoidism and its effects on calcium balance and consequent effects on cotractility of the smooth muscle cells of the vessel wall, correction of renal anemia in patients receiving human recombinant erythropoietin, regulation of salt intake, and frequency and duration of haemodialysis procedure have also a significant role in BP regulation in these patients. If dialysis procedure is not adequate, meaning that salt and water balance is not satisfyng, antihypertensive medications cannot alone control BP in haemodialysis patients.