[Arterial hypertension in dialysis: up to what point should it be corrected? It depends]

It is well known that blood pressure values <130/80 mmHg in high-risk patients (diabetics, heart patients) reduces the cardiovascular risk, and it is equally well known that the same target is advised for patients with renal insufficiency. In view of the elevated prevalence of postural hypotension, autonomic dysfunction and peripheral, cerebral and cardiac vasculopathy in kidney patients, the maintenance of this pressure target can, however, be harmful in this category of patients. Indeed, some studies have shown that lower pressure values are associated with more cardiovascular events in dialysis patients. The increased incidence of organ damage consequent to the hypotensive episodes that may occur in these patients should also be taken into account. Hypotension during dialysis, especially when occurring repeatedly, has indeed been indentified as the cause of the increased risk of intestinal, cardiac and cerebral ischemia in such patients. Antihypertensive treatment must therefore be seen in a different light compared with that of the general population, and we should consider the anatomic and physiopathological peculiarities of dialysis patients. It thus becomes of primary importance to assess the presence of comorbidities and cardiovascular risk factors that may favor the maintenance of pressure values that are not necessarily extremely low. A carefully reasoned use of antihypertensive drugs which takes these aspects into account could reduce the incidence of ischemic events with consequent organ damage that can increase dialysis patient mortality.