Hypertension in hemodialysis patients

Hypertension confers higher cardiovascular (CV) risk in hemodialysis (HD) patients, perhaps because patients with CKD have a high burden of traditional cardiovascular risk factors in addition to a range of non-traditional risk factors such as anemia, left ventricular hypertrophy, inflammation and abnormal metabolism of calcium and phosphate. Potentially beneficial therapies are sometime under used in patients with end stage renal disease and are rarely studied in patients on dialysis. Newer studies using home BP and ambulatory BP during 24 hours have provided a narrower range of BP values that may reduce CV risk. Ambulatory blood pressure (BP) monitoring is a growing tool for hypertension evaluation along with changes in vascular compliance. Home BP values on interdialytic days are practical and also demonstrate good correlations with ambulatory readings. In this review, we describe the epidemiology, the pathogenetic mechanisms that underlie blood pressure over load in dialysis patients and outline traditional and non traditional cardiovascular risk factors that are relevant in this population.