Management of hypertension in hemodialysis patients

Abstract

Hypertension occurs in 50–90% of hemodialysis patients and is one of the main causes of increased cardiovascular risk in these patients. The factors responsible for the development of hypertension in this population include water retention, activation of the sympathetic nervous and the rennin–angiotensin– aldosterone systems, calcium–phosphate disturbances, impaired secretory function of vascular endothelial cells, obstructive sleep apnea or treatment with erythropoiesis stimulating agents. The reference method in terms of diagnosis, monitoring of treatment and prognosis seems to be 44 hours automated ambulatory blood pressure measurement. This method is, however, the cost and poorly accepted by patients. So it is recommended that the patients should record themselves their blood pressure measurements at home in interdialytic period. Recent recommendations of the JNC 8, KDIGO and ESH/ESC guidelines do not clearly indicate the optimal values of blood pressure in patients treated with hemodialysis. According to the recommendations NKF/KDOQI of 2005 the target blood pressure before HD should be < 140/90 mm Hg, and after HD < 130/80 mm Hg. Optimal blood pressure in an outpatient setting should be ≤ 135/85 mm Hg during the day and ≤ 120/80 mm Hg at night. The basic method to bring blood pressure to normal is to achieve the patient „dry weight”. The profiling sodium concentration in the dialysate and to limit its intake in the diet is helpful. Pharmacological reduction of blood pressure is associated with a reduced risk of cardiovascular events and cardiovascular mortality. Increasing the frequency and/or duration of dialysis may also be treated as an alternative method of treatment of hypertension.