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.
Despite advances in BP management in the general population, hypertension remains a challenge to control in the chronic HD population. In a study of 2,535 clinically stable adult HD patients, 86% were found to be hypertensive. Within this hypertensive group, only 30% had their BP under adequate control, 58% were inadequately treated, and 12% were not treated at all.
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