A15199 Resistant hypertension in dialyzed patients- how to define it properly

Abstract

Objectives: Hypertension (HTN) is an overwhelming finding in dialysis patients and the blood pressure (BP) control is often very poor in this group. Resistant hypertension is defined as inability to reach blood pressure below 140/90 mm Hg despite treatment with 3 hypotensive drugs including diuretic. The etiology of HTN in end-stage renal disease is multifactorial. The aim of the study was to assess blood pressure control in 104 hemodialysis (HD group) and 64 peritoneal dialysis (PD group) patients. Methods: The medical history, BP measurements, residual diuresis, laboratory tests, the presence of peripheral edema type of hypotensive therapy, the presence of volume overload, the presence of residual diuresis and BP control was analyzed. Results: HD patients were significantly older than PD group (Me = 64 vs. Me = 57,5y, p < 0,05) with longer dialysis vintage (p < 0,05), with lower diastolic BP, lower residual renal function (44% vs. 62%, p < 0,05). Prevalence of resistant hypertension was 44% in HD population and 63% in PD (p < 0.01). The peripheral edema was observed significantly more often in PD group with uncontrolled BP (above 140/90 mmHg) (72,2% vs 35,7%, p < 0,05). The average amount of hypotensive drugs was 3 in HD and 4 in PD patients. The most used hypotensive drug was beta-blocker. PD patients were treated with ACEi and ARB significantly wider (p < 0,05). Conclusion: BP and volume control are more satisfactory in HD group. However, definition of resistant hypertension in dialyzed patients should be modified accordingly as diuretics are not used in patients without residual renal function. It should be also stated which BP measurements are valid for definition of resistant hypertension (before, after, between HD).