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.