Treatment of hypertension in dialysis patients.
Hypertension is common in hemodialyzed patients and constitutes an important cardiovascular risk factor. Fluid retention, inappropriate stimulation of the renin-angiotensin system, sympathetic overactivity and changes of vessel wall structure have been shown to be important factors in its pathogenesis. It has been claimed that hemofiltration permits a better control of hypertension in the interdialytic interval, although the evidence is not perfectly convincing; blood pressure tends to be lower with continuous ambulatory peritoneal dialysis. While fluid withdrawal and - within certain limits - adjustment of dialysate sodium concentration constitutes a primary line of therapy, antihypertensive medication is necessary in approximately 20% of patients. Specific problems with dialysis patients are cumulation of drugs (some cardioselective beta-blockers, alpha-methyldopa, captopril), altered dose-response relationship (diuretics) and particularly interaction with cardiovascular stability during fluid withdrawal.
Klooker
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Bommer
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Ritz
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D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000378:metabolism / Q000627:therapeutic use; D000328:Adult; D000818:Animals; D000959:Antihypertensive Agents / Q000378:metabolism / Q000627:therapeutic use; D001341:Autonomic Nervous System / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects; D001810:Blood Volume; D002121:Calcium Channel Blockers / Q000378:metabolism / Q000627:therapeutic use; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use; D004285:Dogs; D006801:Humans; D006977:Hypertension, Renal / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D006435:Renal Dialysis; D012084:Renin-Angiotensin System; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D014665:Vasodilator Agents