Hypertension is poorly controlled in hemodialysis (HD). Extracellular fluid volume control, restriction of salt intake and antihypertensive therapy are needed to control blood pressure (BP) control in this population. Research on patterns of antihypertensive use on BP has not been extensively studied in the chronic HD population. Participants were taking an average of three antihypertensive medications. Total number of antihypertensive medications was not correlated with BP. There were no differences in BPs in patients who took or did not take a specific antihypertensive drug class except for ace-inhibitors. Those participants who did take ace-inhibitors had significantly higher BPs. Future studies examining antihypertensive class, optimal dosing and time of administration need to be conducted to determine the best hypertensive management intervention for chronic HD patients.
The estimated prevalence of hypertension in chronic Hemodialysis (HD) patients is 60 - 90%. Hypertension in the chronic HD population is a major contributor to cardiovascular morbidity and mortality. There is a 20 fold greater incidence of cardiovascular mortality in the End Stage Renal Disease (ESRD) population compared to the general population without renal failure. Systemic hypertension has been identified as a major risk factor for the progression of atherosclerosis, left ventricular hypertrophy, left ventricular dilation, heart failure and death. According to Ritz and Koch, hypertension is the single most important predictor of coronary artery disease in uremic patients, even more so than cigarette smoking and hypertriglyceridemia. Agarwal and Sinha demonstrated that control of Blood Pressure (BP) in HD patients regresses left ventricular hypertrophy and improves cardiovascular morbidity and mortality. According to National Kidney Foundation Kidney Diseases Outcomes Quality Initiative guidelines (NKF KDOQI) (2005), the goal for predialysis and post dialysis blood pressure should be <140/90 mm Hg and <130/80 mm Hg respectively.