期刊
CURRENT OPINION IN NEPHROLOGY AND HYPERTENSION
卷 21, 期 1, 页码 15-23出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MNH.0b013e32834db3e4
关键词
ambulatory blood pressure; endothelial cell dysfunction; hemodialysis; hypertension; intradialytic hypertension
资金
- UT Southwestern O'Brien Center
- NIH UT [UL1RR024982]
- NIH [K23 HL092297, F32DK085965-O1A1, K24DK002818-06.]
Purpose of review Hypertension is common in hemodialysis patients and contributes to this population's high risk for cardiovascular morbidity and mortality. Patients with intradialytic hypertension, or increases in blood pressure during hemodialysis, have been shown to have the highest risk for these outcomes. The purpose of this review is to describe new findings that shed light on the epidemiology and pathophysiology of intradialytic hypertension and discuss how a better understanding of these mechanisms may lead to improved blood pressure management and outcomes in hemodialysis patients. Recent findings Our laboratory demonstrated that intradialytic hypertension occurs at least sporadically in most hemodialysis patients, but in 25% of patients it occurs in over 31% of their hemodialysis treatments. We also identified that, compared with hemodialysis patients without intradialytic hypertension, those with intradialytic hypertension have worse endothelial cell function and have higher interdialytic ambulatory blood pressure. Pilot study data show that carvedilol reduces the frequency of intradialytic hypertension and improves endothelial cell dysfunction. Summary Intradialytic hypertension is associated with increased morbidity and mortality, impaired endothelial cell function, and higher overall blood pressure burden. Further investigation is required to determine whether interventions aimed at preventing or treating intradialytic hypertension improve long-term outcomes.
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