Antihypertensive Therapie bei CKD-Stadium 5

Abstract

More than 50% of dialysis patients suffer from arterial hypertension. Problems of antihypertensive treatment in terminal kidney failure arise due to excessively increased vascular stiffness and a tonic activation of the sympathetic nerve system. The target blood pressure values for younger patients are < 140/90 mm Hg before dialysis and < 130/80 mm Hg after hemodialysis and for older patients with comorbidities higher systolic values may be tolerated. Diastolic blood pressure values < 70 mm Hg should not be strived for. Antihypertensive treatment favorably influences the prognosis of hypertensive dialysis patients. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor antagonists and calcium channel blockers appear to be advantageous. Reserve antihypertensive medications, such as direct vasodilators and centrally acting sympatholytic drugs, effect a clear lowering of blood pressure but do not favorably influence the cardiovascular prognosis. Of utmost importance is a dietary salt restriction. An adequate volume control is achieved without excessive ultrafiltration rates, with gradual reduction of the dry weight, more frequent dialysis when applicable and especially sufficiently long duration of hemodialysis.