J Clin Outcomes Manage
Management of hypertension in the end-stage renal disease patient
Singapuri MS, Lea JP
Abstract Objective: To discuss mechanisms involved in blood pressure dysregulation in patients on hemodialysis and present strategies to improve blood pressure control in end-stage renal disease (ESRD) patients. Methods: Review of the literature. Results: Blood pressure control is not adequate in a vast majority of hemodialysis patients, which in turn translates into an elevated rate of cardiovascular disease. Although ambulatory blood pressure monitoring provides a superior assessment of blood pressure, its utilization is limited. Home blood pressure measurements are a reliable and inexpensive method to help diagnose occult hypertension in chronic hemodialysis patients. Aiming for a blood pressure of less than 140/90 mm Hg or the lowest possible value as tolerated by the patient should be the target. Achievement of dry weight is a key factor in obtaining optimal blood pressure control. Salt restriction to less than 2 g per day should be reinforced. Adequate blood pressure control usually will require pharmacologic therapy and it should be tailored according to the physiology of the patient as well as to the presence of other end-organ damage and disease comorbidities. Conclusion: To reduce the disease burden in patients with ESRD, vigorous control of hypertension is recommended.
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