Summary
Hypertension is the leading risk factor for premature disability and death worldwide, across all socioeconomic statuses.
In a survey of 2535 hemodialysis patients from 69 dialysis units in the United States, the prevalence of hypertension was 86%. Although many patients received antihypertensive drugs, only 30% had well-controlled BP, 58% had poorly controlled BP, and 12% had untreated hypertension.
There is an inverse association between blood pressure (BP) values and death in MHD patients. In current study, the death risk is most prominent when systolic and diastolic BP values are 135mm Hg and /or diastolic blood pressure >85 mmHg.
24h-ABPM measurement :systolic BP>130 mm Hg and /or diastolic pressure >80 mm Hg .
If home or 24h-ABPM cannot be applied , hypertension can be diagnosed as :
Midweek median intradialysis systolic BP>140 and/or diastolic pressure >90 mm Hg when patient is believed to be at dry body weight.
There are 3 ways in which we can assess the level of BP in a hemodialysis patient. It can be obtained before, during, and after dialysis by the dialysis staff, at home by the patient, or by an automatic ambulatory BP monitor.
Management of patients on hemodialysis is challenging. It may be divided into 2 broad categories: non pharmacologic and pharmacologic
Reduction of salt intake is the first line to achieve adequate blood pressure control . Salt restriction to 1000 mg/day or less helps decrease thirst and control interdialytic fluid gain. Sodium balance also achieved by reducing dialysate sodium concentration.
All classes of antihypertensive drugs can be used in dialysis patients, with the sole exception of diuretics. Consideration should be given to the coexisting diseases. In the United States 72% of the hemodyalisis patients received antihypertensive medication (48% were prescribed calcium antagonists, 24%angiotensin-converting enzyme (ACE) inhibitors, and 21% β-blockers).
The National Kidney Foundation K/DOQI guidelines suggest that predialysis and postdialysis BPs should be |
