Research progress on hypertension management in hemodialysis patients

The morbidity of hypertension in patients with chronic hemodialysis is very high. Effective management of hypertension in such patients can reduce the mortality of cardio-cerebrovascular diseases. Blood pressure target for dialysis patients is not clear, but too high or too low blood pressure will increase mortality of such patients. Ambulatory blood pressure monitoring (ABPM) during interdialysis sessions is more beneficial to the diagnosis and management of hypertension than that during intradialysis sessions. Maintaining interdialytic ABPM<135/85 mmHg in daytime and ABPM<120/80 mmHg in nighttime are recommended. Dialysis is the most important treatment of hypertension in chronic hemodialysis patients. The first strategy is volume control and target dry weight achievement, which should be done gradually. In addition, personalized sodium dialysate prescription and high-frequency long-term dialysis are beneficial to the control of blood pressure. If patients do not respond to volume control strategy, antihypertensive drugs will be required. The selection of antihypertensive drugs should take into account the effectiveness, safety, cardiac protection, pharmacokinetics, clearance rate of dialyzer and potential complications of different drugs. Except for diuretics, nearly all kinds of antihypertensive drugs are effective for the treatment of hypertension in dialysis patients. Beta receptor blockers may provide greater cardiac protection in dialysis patients compared with normal population. In this paper, we review the literature in the last 10 years, and summarize the research progress in the management of hypertension in patients with chronic hemodialysis.