ISSN: 1305-385X
Hakkında: Özel sayılar şeklinde yayınlanır.
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Pharmacological Management Of Hypertension Treatment In Dialysis Patients
Dr. Yahya SAĞLIKER,a Dr. Hasan Sabit SAĞLIKER,a Dr. Pırıl SAĞLIKER ÖZKAYNAKa
aİç Hastalıkları AD, Nefroloji BD, Çukurova Üniversitesi Tıp Fakültesi, ADANA
As in patients with renal failure without the need for dialysis, the main mechanisms that contribute to the pathogenesis of hypertension in dialysis patients are salt and water retention and activation of the renin-angiotensin-aldosterone system (RAAS). Diuretics may be beneficial for the treatment of hypertension in dialysis patients with significant urine output, particularly because these drugs do not require dose reduction owing to their hepatic degradation. Other anti-hypertensive alternatives are needed as urine output declines. Beta adrenergic blocker drugs, particularly labetalol and carvedilol which also have alpha adrenergic blocker properties, can be preferred in high-renin states and their hepatic metabolism facilitates their use in dialysis patients. In addition to calcium channel blockers, drugs that comprise the angiotensin converting enzyme inhibitor (ACEI) group, especially those eliminated via the liver (fosinopril and spirapril) and angiotensin receptor blocker (ARB) agents can also be used for the treatment of hypertension in dialysis patients. This review summarizes the pharmacologic management of hypertension treatment in dialysis patients and emphasizes the following basic principles:
1. The first step in controlling hypertension in patients with choronic renal failure on chronic dialysis treatment is preventing fluid excess. This approach should be reinforced by educating patients on the importance of salt and water restriction.
2. The results of studies on long term blood pressure control in dialysis populations indicate that the need for the roles of ACEIs and ARBs may gradually increase.Keywords: Blood pressure, hypertension, chronic renal failure, hemodialysis, antihypertensive therapyTurkiye Klinikleri J Int Med Sci 2005, 1(38):115-119
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