Management of hypertension in patients with end-stage renal disease leading to haemodialysis: a challenge
Keywords:Antihypertensives, ESRD, Hemodialysis
The majority of the patients of end-stage renal disease (ESRD) leading to haemodialysis suffer from hypertension. Increase in blood pressure is both a cause and a consequence of chronic kidney disease and inadequate control of blood pressure in these patients increases the risk of development of left ventricular hypertrophy, congestive heart failure, stroke and other cardiovascular and neurological complications leading to high morbidity and mortality in these patients. In a meta-analysis of randomized controlled trials of antihypertensive therapy in haemodialysis patients, blood pressure lowering treatment was associated with a 29% lower relative risk of cardiovascular mortality and a 20% lower relative risk of all-cause mortality. While blood pressure control may improve cardiovascular mortality and morbidity, the management of hypertension is a big challenge in these patients especially in developing countries like India where the maintenance of optimal dry weight in between the dialysis therapy is inadequate due to high cost of hemodialysis and limited number of centers providing dialysis therapy. The aim of the present review the evidence on the optimal systolic and diastolic blood pressure in the patients on haemodialysis and the most effective drug or group of drugs that can provide adequate blood pressure control in all phases of dialysis (pre, post, intra and interdialytic phases) without complications like intradialytic hypotension or hypertension and good patient compliance.
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