[Arterial hypertension in dialysis: the need of a tailorized treatment]

There is no doubt that arterial hypertension in dialysis patients as well as in patients without renal disease is deleterious for the cardiovascular system. Reducing the pressure values to 130/80 mmHg is what the guidelines suggest. The dialysis setting, however, presents a very different scenario from that of the general population. Dialysis per se is the most powerful of the pharmacological measures in blood pressure control. At the same time, dialysis is an interfering factor in pressure control and can even foster the onset of a perverse vicious circle with, in the same patient, the onset of severe intradialysis hypotension and hypertensive crises in the interdialysis period. An obstinate pursuit of normal pressure values may give rise to sudden reductions in the arterial pressure that can generate vascular damage in various districts (cerebral, cardiac, mesenteric). From these premises arises the need to individualize, as far as possible, not only the pharmacological therapy but also the dialysis prescription in ways that will avert hypotension during the session and at the same time correct the chronic water and salt overload that occurs in the dialysis patient.