Optimizing hypertension control in hemodialysis patients: a proposed management strategy.
OBJECTIVE
The purpose of the study was to assess the efficiency of a goal-oriented therapeutic strategy in lowering blood pressure and reducing the need for antihypertensive medications in 168 patients undergoing long-term hemodialysis.


METHODS
Patients were managed initially by achieving optimal dry weight. After reduction of the dry weight, patients with uncontrolled arterial hypertension were dialyzed using a 1.25 mmol/L calcium concentration buffer.


RESULTS
The predialysis mean arterial blood pressure (PDBP) was 127.4/74.2 mmHg for the total population. Fifty (29.76%) of the total study population were hypertensive. Of them, 88% (44 patients) were receiving antihypertensive drugs, while the others were not on such medications. Twenty patients (40% of the hypertensives) were receiving one antihypertensive drug, 17 (34%) were receiving two antihypertensive drugs, while 7 patients (14%) were receiving three or more drugs. There was a significant increase in the number of patients with good control of PDBP in the second data collection [45 patients (90%)] compared to the first data collection of 40 patients (80%). Similarly, there was a significant reduction in the number of patients with uncontrolled PDBP in the second data collection (5 patients (10%) compared to the first data collection of 10 patients (20%). The average blood pressure in the first data collection was 137.2/76.3 and 167.4/87.1 mmHg in the controlled and uncontrolled blood pressure groups respectively. In the second data collection, the average blood pressure was 136.4/75.1 and 161.6/86.3 mmHg in the controlled and uncontrolled groups respectively.


CONCLUSIONS
Therapeutic approach using combination of dry weight reduction and dialysis with low calcium dialysate provides acceptable long-term results in patients with arterial hypertension and reduces the need for antihypertensive medication.
Department of Nephrology and Dialysis, Ibn Rochd University Hospital Center, 20100 Casablanca, Morocco. faissal76@hotmail.com
Faissal
F
Tarrass
Karima
K
Addou
Meryem
M
Benjelloun
Mohamed
M
Zamd
Ghislaine
G
Medkouri
Khadija
K
Hachim
Mohamed Gharbi
MG
Benghanem
Benyounes
B
Ramdani
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001835:Body Weight; D005260:Female; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis