Title: Resistant Hypertension in Hemodialysis Patients
Authors: Ahmad B. Elden, Walaa H. Mohamad, Muhammad Hosam Magraby
DOI: http://dx.doi.org/10.18535/jmscr/v4i6.17
Objectives: This study aimed to assess prevalence of resistant hypertension (RHT) in hemodialysis (HD) patients. Patients and Methods: We conducted a cross sectional study on 135 HD patients. RHT was defined as failure to reach target blood pressure (BP) control (systolic BP <140 mmHg and diastolic BP < 90 mmHg) with maximal dose of 3 antihypertensive therapies (AHT) including diuretics in patients with good daily urine output (> 500 cc/day) or at least 2 L/session ultra filtration volume in oliguric (<500-100 cc/day) or anuric patients (< 50 cc /day). Patients with post HD hypertension underwent 24h ambulatory monitor for their BP, which hourly measured their BP. Results: In our study; 34 (25.2%) of patients were non hypertensives, 43 (31.8%) were controlled hypertensives, 58 (43.0%) were uncontrolled hypertensives. Uncontrolled hypertensives with inadequate AHT were 53 (39.2 %), where RHT patients were 5 (3.7%) of all study population. Conclusions: We concluded that RHT had3.7% prevalence in HD patients. Keywords: resistant hypertension, haemodialysis. 1- Venkata C., RamS. and Andrew Z. Fenves: Management of Hypertension in Hemodialysis Patients. Current Hypertension Reports 2009, 11:292–98 2- Calhoun DA, Jones D, Textor S, et al: Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 2008;51(6):1403-19. 3- Heerspink HJL, Ninomiya T, Zoungas S, de Zeeuw D, Grobbee DE and Jardine MJ, et al: Effect of lowering blood pressureon cardiovascular events and mortality in patients on dialysis:A systematic review and meta-analysis of randomised controlledtrials. Lancet 2009; 373: 1009-15. 4- Henrich WL and Lionel U. Mailloux: In: Schwab SJ, et al. eds. Hypertension in hemodialysis patients. Waltham, MA: Up to Date2013. 5- Daugherty S.L., Powers J.D. and Magid D.J:Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation 2012;125:1635-42. 6- Bargman JM, Thorpe KE and Churchill DN: Relative contribution of residual renal functionand peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSAstudy. Journal of American Society of Nephrology 2001, 12 (10): 2158-62. 7- Konings CJ, Kooman JP, Schonck M, Struijk DG, Gladziwa U, Hoorntje SJ, van der Wall Bake AW, van der Sande FM and Leunissen KM: Fluid status in CAPD patients isrelated to peritoneal transport and residual renal function: Evidence from alongitudinal study. Nephrology Dialysis Transplant 2003; 18(4): 797-803 8- Wang AY, Wang M, Woo J, Lam CW, Lui SF, Li PK and Sanderson JE: Inflammation, residual renal function, and cardiac hypertrophy are interrelated and combine adversely to enhance mortality and cardiovascular death risk of peritoneal dialysis patients. Journal of American Society of Nephrology2004, 15(8): 2186-94. 9- Pecoits-Filho R, Heimburger O, Barany P, Barany P, Suliman M, Fehrman-Ekholm I, Lindholm B and Stenvinkel P: Associations between circulating inflammatorymarkers and residual renal function in CRF patients. American Journal of Kidney Disease 2003,41(6): 1208-12. 10- Jeffrey Thomas and Isaac Teitelbaum: Preservation of Residual Renal Function in Dialysis Patients.Advances in Peritoneal Dialysis 2011; 27. 11- Rahman M, Dixit A, Donley V, Gupta S, Hanslik T, Lacson E, Ogundipe A, Weigel K and Smith MC:Factors associated with inadequate blood pressure control in hyperte-nsive hemodialysis patients.American Journal of Kidney Disease 1999, 33(3):498-506. 12- Nabela Enam, Kavita Kakkad, Akshay Amin and Carole Lever:Management of hypertension in the hemodialysispopulation: a review of the literature. Journal of Community Hospital Internal Medicine Perspectives. 2014; 4(3): 10.3402/jchimp.v4.24055.Abstract
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