Blood pressure management in hemodialysis: what have we learned?
Summary of "Blood pressure management in hemodialysis: what have we learned?"
PURPOSE OF
REVIEW:
To review recent developments in the field of hypertension in hemodialysis patients. RECENT
FINDINGS:
Despite the fact that hypertension is the most common complication of end-stage kidney disease, no evidence-based blood pressure (BP) targets exist for hemodialysis patients. There is growing evidence that outcomes are better predicted by out-of-office BP values, such as home or ambulatory BP monitoring. Intradialytic hypertension is associated with increased risk of death or hospitalization, and is probably mediated by volume overload. BP management should focus on volume control: dry weight 'probing' is well tolerated and effective in lowering BP, as are other strategies that minimize expansion of the extracellular fluid volume, such as avoidance of hypernatric dialysate. We discuss each of these issues in our review.
SUMMARY:
Modest advances in the understanding of hypertension have occurred in the past 2 years. Clinical trials that focus on BP targets and treatment choices are essential to guide future practice.
Affiliation
aMedical Service, VA Connecticut Healthcare System, West Haven, USA bSection of Nephrology, Yale University School of Medicine, New Haven, Connecticut, USA cDivision of Nephrology, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro,
Journal Details
This article was published in the following journal.
Name: Current opinion in nephrology and hypertension
ISSN: 1535-3842
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20827194
- DOI: http://dx.doi.org/10.1097/MNH.0b013e32833f0d82
Medical and Biotech [MESH] Definitions
Blood Pressure Monitoring, Ambulatory
Method in which repeated blood pressure readings are made while the patient undergoes normal daily activities. It allows quantitative analysis of the high blood pressure load over time, can help distinguish between types of HYPERTENSION, and can assess the effectiveness of antihypertensive therapy.
Hypertension
Persistently high systemic arterial BLOOD PRESSURE. Based on multiple readings (BLOOD PRESSURE DETERMINATION), hypertension is currently defined as when SYSTOLIC PRESSURE is consistently greater than 140 mm Hg or when DIASTOLIC PRESSURE is consistently 90 mm Hg or more.
Hemodialysis Units, Hospital
Hospital units in which care is provided the hemodialysis patient. This includes hemodialysis centers in hospitals.
Baroreflex
A response by the BARORECEPTORS to increased BLOOD PRESSURE. Increased pressure stretches BLOOD VESSELS which activates the baroreceptors in the vessel walls. The net response of the CENTRAL NERVOUS SYSTEM is a reduction of central sympathetic outflow. This reduces blood pressure both by decreasing peripheral VASCULAR RESISTANCE and by lowering CARDIAC OUTPUT. Because the baroreceptors are tonically active, the baroreflex can compensate rapidly for both increases and decreases in blood pressure.
Helplessness, Learned
Learned expectation that one's responses are independent of reward and, hence, do not predict or control the occurrence of rewards. Learned helplessness derives from a history, experimentally induced or naturally occurring, of having received punishment/aversive stimulation regardless of responses made. Such circumstances result in an impaired ability to learn. Used for human or animal populations. (APA, Thesaurus of Psychological Index Terms, 1994)
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