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Review
. 2019 Jul-Sep;41(3):400-411.
doi: 10.1590/2175-8239-jbn-2018-0155. Epub 2018 Nov 8.

Hypertension in patients on dialysis: diagnosis, mechanisms, and management

[Article in English, Portuguese]
Sérgio Gardano Elias Bucharles  1   2 , Krissia K S Wallbach  1 , Thyago Proença de Moraes  3 , Roberto Pecoits-Filho  3
Affiliations
Review

Hypertension in patients on dialysis: diagnosis, mechanisms, and management

[Article in English, Portuguese]
Sérgio Gardano Elias Bucharles et al. J Bras Nefrol. 2019 Jul-Sep.

Abstract

Hypertension (blood pressure > 140/90 mm Hg) is very common in patients undergoing regular dialysis, with a prevalence of 70-80%, and only the minority has adequate blood pressure (BP) control. In contrast to the unclear association of predialytic BP recordings with cardiovascular mortality, prospective studies showed that interdialytic BP, recorded as home BP or by ambulatory blood pressure monitoring in hemodialysis patients, associates more closely with mortality and cardiovascular events. Although BP is measured frequently in the dialysis treatment environment, aspects related to the measurement technique traditionally employed may be unsatisfactory. Several other tools are now available and being used in clinical trials and in clinical practice to evaluate and treat elevated BP in chronic kidney disease (CKD) patients. While we wait for the ongoing review of the CKD Blood Pressure KIDGO guidelines, there is no guideline for the dialysis population addressing this important issue. Thus, the objective of this review is to provide a critical analysis of the information available on the epidemiology, pathogenic mechanisms, and the main pillars involved in the management of blood pressure in stage 5-D CKD, based on current knowledge.

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Figures

Figure 1
Figure 1. Factors involved in the development of hypertension in dialysis patients.
See this image and copyright information in PMC

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