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Review
. 2014 Aug;25(8):1630-46.
doi: 10.1681/ASN.2013060601. Epub 2014 Apr 3.

Assessment and management of hypertension in patients on dialysis

Rajiv Agarwal  1 , Joseph Flynn  2 , Velvie Pogue  3 , Mahboob Rahman  4 , Efrain Reisin  5 , Matthew R Weir  6
Affiliations
Review

Assessment and management of hypertension in patients on dialysis

Rajiv Agarwal et al. J Am Soc Nephrol. 2014 Aug.

Abstract

Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD.

Keywords: dialysis; hemodialysis; hypertension.

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Figures

Figure 1.
Figure 1.
Modeled trended cosinor BP and pulse rate in HD patients. Notice the linear trend in SBP, DBP, and pulse pressure but the lack thereof in heart rate. Reprinted from reference 67, with permission.
Figure 2.
Figure 2.
The effect of dry weight reduction on interdialytic ambulatory SBP and DBP in hypertensive HD patients. The mean SBPs (A) and DBPs (B) are shown for the baseline control and ultrafiltration groups. The mean changes in BP are shown for weeks 4 and 8 after randomization (solid arrows), and the mean differences in BPs (dotted arrows) between the two groups at each 4-week interval. The numbers next to the dotted lines connecting the data points are the mean changes in BP between groups at 4 and 8 weeks after randomization. The 95% confidence intervals (95% CIs) are given in parentheses. Significant differences between groups or within groups are as indicated as follows: *P<0.05; †P<0.01; ‡P<0.001. The ultrafiltration-attributable change in SBP was −6.9 mmHg (95% CI, −12.4 to −1.3 mmHg; P=0.02) at 4 weeks and −6.6 mmHg (95% CI, −12.2 to −1.0 mmHg; P=0.02) at 8 weeks. The ultrafiltration-attributable change in DBP was −3.1 mmHg (95% CI, −6.2 to −0.02 mmHg; P=0.05) at 4 weeks and −3.3 mmHg (95% CI, −6.4 to −0.2 mmHg; P=0.04) at 8 weeks. Reprinted from reference 77, with permission.
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References

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