Hypertension in end-stage renal disease: different measures and their prognostic significance

Hypertension is a risk factor for cardiovascular morbidity and mortality. Hypertension affects the majority of haemodialysis (HD) patients. However, in the absence of prospective data, accurate assessment of blood pressure (BP) and the level to which BP should be targeted remain still to be defined. A direct relationship between volume status and BP as well as between hypervolaemia and morbidity and mortality in HD patients indicates that normovolaemia is the key therapeutic target. Dry-weight reduction by additional ultrafiltration (even in the absence of clinical signs of volume overload) combined with daily dietary salt restriction or individually lowered dialysate sodium is recommended. Strict volume control allows marked reduction of antihypertensive drug treatment or makes it even unnecessary. Long, slow, home HD or frequent, short HD sessions or nocturnal HD also result in reduction of BP and left ventricular hypertrophy in end-stage renal disease patients. It will be interesting to see which recommendations will come from a conference sponsored by the Kidney Disease: Improving Global Outcomes on optimal BP treatment target in relation to end-organ damage and outcomes in HD patients, on antihypertensive drugs and on non-pharmacological therapies are to be considered in achieving BP targets in this population based on a paucity of prospective data.