TY - JOUR
T1 - Hypertension in dialysis patients
T2 - a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH)
AU - Sarafidis, Pantelis A.
AU - Persu, Alexandre
AU - Agarwal, Rajiv
AU - Burnier, Michel
AU - de Leeuw, Peter
AU - Ferro, Charles
AU - Halimi, Jean-Michel
AU - Heine, Gunnar
AU - Jadoul, Michel
AU - Jarraya, Faical
AU - Kanbay, Mehmet
AU - Mallamaci, Francesca
AU - Mark, Patrick B.
AU - Ortiz, Alberto
AU - Parati, Gianfranco
AU - Pontremoli, Roberto
AU - Rossignol, Patrick
AU - Ruilope, Luis
AU - Van der Niepen, Patricia
AU - Vanholder, Raymond
AU - Verhaar, Marianne C.
AU - Wiecek, Andrzej
AU - Wuerzner, Gregoire
AU - London, Gerard M.
AU - Zoccali, Carmine
PY - 2017/4
Y1 - 2017/4
N2 - In patients with end-stage renal disease treated with hemodialysis or peritoneal dialysis, hypertension is very common and often poorly controlled. Blood pressure (BP) recordings obtained before or after hemodialysis display a J-shaped or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar hemodynamic setting related with dialysis treatment. Elevated BP by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnea and the use of erythropoietin-stimulating agents may also be involved. Nonpharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium-volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient's comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the diagnosis, epidemiology, pathogenesis and treatment of hypertension in patients on dialysis, aiming to offer the renal physician practical recommendations based on current knowledge and expert opinion and to highlight areas for future research.
AB - In patients with end-stage renal disease treated with hemodialysis or peritoneal dialysis, hypertension is very common and often poorly controlled. Blood pressure (BP) recordings obtained before or after hemodialysis display a J-shaped or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar hemodynamic setting related with dialysis treatment. Elevated BP by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnea and the use of erythropoietin-stimulating agents may also be involved. Nonpharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium-volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient's comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the diagnosis, epidemiology, pathogenesis and treatment of hypertension in patients on dialysis, aiming to offer the renal physician practical recommendations based on current knowledge and expert opinion and to highlight areas for future research.
KW - blood pressure
KW - dry-weight
KW - end-stage renal disease
KW - hemodialysis
KW - hypertension
KW - peritoneal dialysis
KW - sodium excess
KW - AMBULATORY BLOOD-PRESSURE
KW - LEFT-VENTRICULAR HYPERTROPHY
KW - RANDOMIZED CONTROLLED-TRIAL
KW - RECOMBINANT-HUMAN-ERYTHROPOIETIN
KW - PATIENTS RECEIVING HEMODIALYSIS
KW - INTERDIALYTIC WEIGHT-GAIN
KW - OBSTRUCTIVE SLEEP-APNEA
KW - IN-CENTER HEMODIALYSIS
KW - HIGH-DOSE FUROSEMIDE
KW - PERITONEAL-DIALYSIS
U2 - 10.1097/HJH.0000000000001283
DO - 10.1097/HJH.0000000000001283
M3 - Article
C2 - 28157814
SN - 0263-6352
VL - 35
SP - 657
EP - 676
JO - Journal of Hypertension
JF - Journal of Hypertension
IS - 4
ER -