The treatment of hypertension in dialyzed patients

Hypertension in chronically dialyzed patients is a frequent complication effecting their cardiovascular morbidity and mortality. The therapy is based on salt and fluid restriction, dietary phosphate restriction and treatment with phosphate binders, correct dialysis strategy and antihypertensive medications. High salt intake and high sodium concentration in dialysis fluid are connected with thirst and increased intake of fluid and it leads with decreased residual diuresis to fluid retention. During dialysis it is necessary to reach optimal dry weight, i. e. body weight without fluid surplus. Sufficient length of dialysis provides ultafiltration of fluid excess with episodes of hypotension. If diet and optimal dry weight are not sufficient to reach the target blood pressure (< 140/90 mmHg), then antihypertensive medications are prescribed. Medications blocking the renin-angiotensin system are the treatment of choice. They decrease mortality of dialysed patients, reduce left ventricular hypertrophy, decrease sympathetic activity and improve endothelial function and decrease oxidative stress. Some antihypertensive medications (some ACE-inhibitors and beta-blockers) are removed by dialysis that is why it is necessary to adjust the medication juice and timing of aplication. We need another controlled clinical study to find an optima treatment of hypertension in dialyse patients.

Keywords: dialysis therapy, hypertension, diet, dry weight, blocker of renin-angiotensin system