Optimizing hypertension control in hemodialysis patients : a proposed management strategy

Objective : The purpose of the study was to assess the efficiency of a goal-oriented therapeutic strategy in lowering blood pressure and reducing the need for antihypertensive medications in 168 patients undergoing long-term hemodialysis. Methods : Patients were managed initially by achieving optimal dry weight. After reduction of the dry weight, patients with uncontrolled arterial hypertension were dialyzed using a 1.25 mmol / L calcium concentration buffer. Results : The predialysis mean arterial blood pressure (PDBP) was 127.4 / 74.2 mmHg for the total population. Fifty (29.76 %) of the total study population were hypertensive. Of them, 88 % (44 patients) were receiving antihypertensive drugs, while the others were not on such medications. Twenty patients (40 % of the hypertensives) were receiving one antihypertensive drug, 17 (34 %) were receiving two antihypertensive drugs, while 7 patients (14 %) were receiving three or more drugs. There was a significant increase in the number of patients with good control of PDBP in the second data collection [45 patients (90 %)] compared to the first data collection of 40 patients (80 %). Similarly, there was a significant reduction in the number of patients with uncontrolled PDBP in the second data collection (5 patients (10 %) compared to the first data collection of 10 patients (20 %). The average blood pressure in the first data collection was 137.2 / 76.3 and 167.4 / 87.1 mmHg in the controlled and uncontrolled blood pressure groups respectively. In the second data collection, the average blood pressure was 136.4 / 75.1 and 161.6 / 86.3 mmHg in the controlled and uncontrolled groups respectively. Conclusion : Therapeutic approach using combination of dry weight reduction and dialysis with low calcium dialysate provides acceptable long-term results in patients with arterial hypertension and reduces the need for antihypertensive medication.