Treatment-resistant hypertension in the hemodialysis population: a 44-h ambulatory blood pressure monitoring-based study.

Abstract:

BACKGROUND:Uncontrolled hypertension notwithstanding the use of at least three drugs or hypertension controlled with at least four drugs, the widely accepted definition of treatment-resistant hypertension (TRH), is considered as a common problem in the hemodialysis population. However, to date there is no estimate of the prevalence of this condition in hemodialysis patients. METHOD:We estimated the prevalence of TRH by 44-h ambulatory BP monitoring (ABPM) in 506 hemodialysis patients in 10 renal units in Europe included in the registry of the European Renal and Cardiovascular Medicine (EURECAm,), a working group of the European Association, European Dialysis and Transplantation Association (ERA EDTA). In a sub-group of 114 patients, we tested the relationship between fluid overload (Body Composition monitor) and TRH. RESULTS:The prevalence of hypertension with 44-h ABPM criteria was estimated at 85.6% (434 out of 506 patients). Of these, 296 (58%) patients were classified as uncontrolled hypertensive patients by 44-h ABPM criteria (≥130/80 mmHg). Two hundred and thirteen patients had uncontrolled hypertension while on treatment with less than three drugs and 210 patients were normotensive while on drug therapy (n = 138) or off drug treatment (n = 72). The prevalence of TRH was 24% (93 among 386 treated hypertensive patients). The prevalence of predialysis fluid overload was 33% among TRH patients, 34% in uncontrolled hypertensive patients and 26% in normotensive patients. The vast majority (67%) of hemodialysis patients with TRH had no fluid overload. CONCLUSION:TRH occurs in about one in four treated hypertensive patients on hemodialysis. Fluid overload per se only in part explains TRH and the 67% of these patients show no fluid overload.

journal_name

J Hypertens

journal_title

Journal of hypertension

authors

Mallamaci F,Torino C,Sarafidis P,Ekart R,Loutradis C,Siamopoulos K,Del Giudice A,Aucella F,Morosetti M,Raptis V,Bikos A,Papagianni A,Balafa O,Pappas E,Tripepi R,Marino C,Tripepi G,Ferro C,Malyszko J,Dekker FW,Jage

doi

10.1097/HJH.0000000000002448

subject

Has Abstract

pub_date

2020-09-01 00:00:00

pages

1849-1856

issue

9

eissn

0263-6352

issn

1473-5598

journal_volume

38

pub_type

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