Dealing with hypertension in hemodialysis patients

Abstract

Hypertension is a well-known cardiovascular risk factor also for hemodialysis patients. Despite being common in this patient population, hypertension is often difficult to diagnose and poorly controlled. Blood pressure variability (BPV) is a new parameter and a predictor of poor outcomes in the general population. A recent observational study in over 11,000 hemodialysis patients showed that high BPV is associated with an increased risk of all-cause mortality, cardiovascular mortality, and first cardiovascular event. High BPV is associated with female gender, black race, obesity, diabetes and/or cardiovascular disease, hemoglobin levels less than 10 g/dL, high calcium-phosphate product, and use of three or more anti-hypertensive drugs. Today, the management of hypertension in hemodialysis patients requires more and more care, not only from the diagnostic point of view, but also in prognosis and therapy, especially regarding the non-pharmacological approach.