Drug therapy for hypertension in hemodialysis patients.


:The majority of end-stage renal disease (ESRD) patients are hypertensive. Drug therapy for hypertension in hemodialysis (HD) patients includes all classes of antihypertensive drugs, with the sole exception of diuretics. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers may decrease morbidity and mortality by reducing the mean arterial pressure (MAP), aortic pulse wave velocity, and aortic systolic pressure augmentation, as well as left ventricular hypertrophy (LVH) and probably reduction of C-reactive protein (CRP) and oxidant stress. Potential risk factors include hyperkalemia, anaphylactoid reaction with AN69 membranes (particularly ACE inhibitors), and aggravation of renal anemia. beta-blockers decrease not only mortality, blood pressure (BP), and ventricular arrhythmias, but also improve left ventricular function in ESRD patients. Nonselective beta-blockers can cause an increase in serum potassium (particularly during fasting or exercise). Lisinopril and atenolol have a predominant renal excretion and therefore a prolonged half life in ESRD patients. Thus thrice-weekly supervised administration of these drugs after HD can enhance BP control. The use of calcium channel blockers is also associated with lower total and cardiovascular-specific mortality in HD patients. Minoxidil is a very potent vasodilator that is generally reserved for dialysis patients with severe hypertension. Hypertensive dialysis patients who are noncompliant with their medications may benefit from transdermal clonidine therapy once a week. The majority of dialysis patients need a combination of several antihypertensive drugs for adequate BP control.


Semin Dial


Seminars in dialysis


Hörl MP,Hörl WH




Has Abstract


2004-07-01 00:00:00














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    abstract::Continuous Renal Replacement Therapy (CRRT) usually requires anticoagulation to prevent clotting of the extracorporeal circuit. Interruptions due to filter clotting significantly reduce total therapy time and CRRT efficacy. Although heparin has traditionally been the most common anticoagulant used for CRRT, increasing...

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  • A multicentre analysis of the outcome of arteriovenous fistula in maintenance haemodialysis.

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    authors: Leblanc M,Ouimet D,Pichette V

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  • Surgical Management of Complications with Peritoneal Dialysis.

    abstract::This report reviews the most common surgical interventions and complications of chronic peritoneal dialysis (PD) patients. Based on the current knowledge as well as our experience we detail the role of these surgical procedures. We supplement the reported knowledge in the field with our own experience in this area. Th...

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    authors: Ratajczak A,Lange-Ratajczak M,Bobkiewicz A,Studniarek A

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    authors: Chhibber V,Weinstein R

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  • Blood pressure control in conventional hemodialysis.

    abstract::Hypertension among patients on hemodialysis is common, difficult to diagnose and often inadequately controlled. Although specific blood pressure (BP) targets in this particular population are not yet established, meta-analyses of randomized trials showed that deliberate BP-lowering with antihypertensive drugs improves...

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  • Intensive hemodialysis in the (nursing) home: the bright side of geriatric ESRD care?

    abstract::Elderly ESRD patients often lose functionality when they start dialysis, which may be due to a variety of clinical problems. We recently postulated that intensive (longer and/or more frequent) hemodialysis (HD) may be the ideal strategy to try to prevent these ESRD- and dialysis-related complications, including dialys...

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    authors: Cornelis T,Kotanko P,Goffin E,van der Sande FM,Kooman JP,Chan CT

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    pub_type: 杂志文章,评审


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    pub_type: 杂志文章,评审


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    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Krishnan M,Lok CE,Jassal SV

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    pub_type: 杂志文章,随机对照试验


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