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Hypertension in Patients Treated With In-Center Maintenance Hemodialysis: Current Evidence and Future Opportunities:

Nisha Bansal, Nancy T Artinian, George Bakris

    Hypertension (Dallas, Tex. : 1979)
    |April 24, 2023
    PubMed

    Insights

    Hypertension affects over 80% of patients on maintenance hemodialysis, a key factor in their high cardiovascular mortality. This review covers defining, diagnosing, and treating this condition in hemodialysis patients.

    Area of Science:

    • Nephrology
    • Cardiovascular Medicine
    • Hypertension Research

    Background:

    • Over 500,000 individuals in the US undergo maintenance hemodialysis for kidney failure.
    • Cardiovascular disease causes approximately 50% of deaths in this patient population.
    • Hypertension is prevalent in >80% of hemodialysis patients and is a modifiable cardiovascular risk factor.

    Purpose of the Study:

    • To review current evidence on hypertension in patients undergoing maintenance hemodialysis.
    • To discuss the definition, diagnosis, and treatment of hypertension in this specific population.
    • To identify areas for future research, including optimal blood pressure targets and therapeutic strategies.

    Main Methods:

    • Literature review of existing scientific evidence.
    • Analysis of multifactorial pathophysiology of hypertension in hemodialysis.
    • Synthesis of current guidelines and research findings.

    Main Results:

    • Hypertension pathophysiology in hemodialysis patients is complex and distinct.
    • Contributing factors include volume overload, arterial stiffness, sympathetic and renin-angiotensin-aldosterone system activity, endothelial dysfunction, and erythropoietin-stimulating agent use.
    • Evidence on optimal management strategies requires further investigation.

    Conclusions:

    • Hypertension is a critical issue in maintenance hemodialysis patients, significantly contributing to cardiovascular mortality.
    • Understanding the unique pathophysiology is essential for effective management.
    • Further research is needed to establish evidence-based blood pressure targets and treatment protocols.

    Keywords:
    AHA Scientific Statementshypertensionkidneyrenal dialysisrenin-angiotensin system

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