Abstract
Aim: To investigate the effect of hemodialysis on blood pressure by monitoring ambulatory blood pressure during the interdialysis period and to evaluate the relationship between hypertension and the percentage of total body water calculated via bioelectrical impedance analysis. Methods: Twenty five patients with end stage renal disease who were in the hemodialysis program were included in the study. But only fifteen patients had been able to stay in the required criteria till the end. Pre- and post-dialysis blood pressures of the patients were measured manually and ambulatory blood pressure measurements were obtained during the interdialysis period. Measurements of total body water were performed with bioelectrical impedance method following the hemodialysis procedure. The patients were evaluated for daily course of blood pressure, use of anti-hypertensive medications, incidence of the falling rate of blood pressure at night, amount of total body water and interdialysis weight gain. Results: Manual pre- and post-dialysis measurements and mean values of 44 hours' ambulatory blood pressure monitoring were found to be similar. Blood pressures were found to be significantly low until the 24th hour and they were increased at the 2nd day, then returned to initial levels at the 44th hour. There was uncontrolled hypertension in 7 of the 11 hypertensive patients (63.6 %). Mean percentage of total body water was higher in patients with hypertension (61.1 ±9.8 vs. 57.9±7.0, p>0.05). Conclusion: In our study, the reducing effect of hemodialysis on blood pressure was observed and this effect has continued nearly 24 hours after the dialysis. The fact that total body water is more in hypertensive patients supports the idea that volume excess is an important factor responsible from hypertension.
Highlights
Angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) are commonly used in clinical practice to treat hypertension and decrease cardiovascular events in highrisk patients [1]
The patients were divided into three groups according to their medications: patients that use anyone of the ACEI, ARB or spironolactone, patients that use combinations of these drugs and patients that do not use these drugs
In our study mean age and rate of the diabetics were high in group that use ACEI, ARB or spironolactone attract our attention
Summary
Angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) are commonly used in clinical practice to treat hypertension and decrease cardiovascular events in highrisk patients [1]. Clinical trials have shown that the addition of spironolactone to ACEI therapy results in clinical improvement among these patients [2,3] and has beneficial effects on left ventricular hypertrophy in essential hypertension [4]. RandomizedAldactone Evaluation Study (RALES) demonstrated that treatment with spironolactone substantially reduced morbidity and mortality in patients with severe heart failure. Spironolactone, as well as ACEI, has been essential in the treatment of heart failure [5]. The most common side effect of ACEI and spironolactone combination therapy is hyperkalemia. Medication-induced hyperkalemia is common, and often life threatening.
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