title: Epidemiology, diagnosis and management of hypertension among patients on chronic dialysis.
abstract: The diagnosis and management of hypertension among patients on chronic dialysis is challenging. Routine peridialytic blood pressure recordings are unable to accurately diagnose hypertension and stratify cardiovascular risk. By contrast, blood pressure recordings taken outside the dialysis setting exhibit clear prognostic associations with survival and might facilitate the diagnosis and long-term management of hypertension. Once accurately diagnosed, management of hypertension in individuals on chronic dialysis should initially involve non-pharmacological strategies to control volume overload. Accordingly, first-line strategies should focus on achieving dry weight, individualizing dialysate sodium concentrations and ensuring dialysis sessions are at least 4 h in duration. If blood pressure remains unresponsive to volume management strategies, pharmacological treatment is required. The choice of appropriate antihypertensive regimen should be individualized taking into account the efficacy, safety, and pharmacokinetic properties of the antihypertensive medications as well as any comorbid conditions and the overall risk profile of the patient. In contrast to their effects in the general hypertensive population, emerging evidence suggests that β-blockers might offer the greatest cardioprotection in hypertensive patients on dialysis. In this Review, we discuss estimates of the epidemiology of hypertension in the dialysis population as well as the challenges in diagnosing and managing hypertension among these patients.
authors: Division of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, St. Kyriakidi 1, Thessaloniki GR54006, Greece.
authors: Panagiotis I
authors: PI
authors: Georgianos
authors: Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Mail Code: 111N, 1481 West 10th Street, Indianapolis 46202-2884 USA.
authors: Rajiv
authors: R
authors: Agarwal
mesh_terms: D000959:Antihypertensive Agents; D001795:Blood Pressure Determination; D001835:Body Weight; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006435:Renal Dialysis
chemical_list: D000959:Antihypertensive Agents