Mechanisms and Treatment of Intradialytic Hypertension.
Mechanisms and Treatment of Intradialytic Hypertension.
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DOI：
10.1159/000441313
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发表时间：
2016
影响因子：
3
通讯作者：
Inrig JK
中科院分区：
文献类型：
--
作者：
Van Buren PN;Inrig JK
分析性高血压是从血液透析前到透析后血压升高，最近已被确定为高血压血液透析患者的独立死亡风险。在过去的几年里，许多研究都在探讨溶栓性高血压的机制和治疗。与其他血液透析患者相比，分析性高血压患者的慢性容量负荷更大，尽管尚未确定因果关系。分析性高血压患者有分析性血管阻力激增，这可能解释了透析期间血压升高。急性血管内内皮细胞功能改变已被认为是血管阻力增加的病因，尽管内皮素-1或其他血管收缩肽是否起作用尚不清楚。透析液与血清钠梯度与透析期间高血压患者血压升高之间存在关联，尽管尚不清楚这是否与内皮细胞活性或急性渗透压改变有关。除了检测分析性高血压患者的干重外，其他管理策略包括降低透析液钠和改变抗高血压药物，包括卡维地洛或其他透析不良的抗高血压药物。与透析期间血压适度降低的患者相比，血液透析合并溶性高血压患者的死亡风险增加。透析期间，除血管阻力急性增加外，透析内高血压还与细胞外容量超载有关。管理策略应包括重新评估干重和修改透析液处方和药物处方。
Intradialytic hypertension is an increase in blood pressure from pre to post hemodialysis that has recently been identified as an independent mortality risk in hypertensive hemodialysis patients. The mechanisms and management of intradialytic hypertension have been explored in numerous research studies over the past few years. Patients with intradialytic hypertension have been found to be more chronically volume overloaded compared to other hemodialysis patients, although no causal role has been established. Patients with intradialytic hypertension have intradialytic vascular resistance surges that likely explain the blood pressure increase during dialysis. Acute intradialytic changes in endothelial cell function have been proposed as etiologies for the increase in vascular resistance, although it is unclear if endothelin-1 or some other vasoconstrictive peptide is responsible. There is an association between dialysate to serum sodium gradients and blood pressure increase during dialysis in patients with intradialytic hypertension, although it is unclear if this is related to endothelial cell activity or acute osmolar changes. In addition to probing the dry weight of patients with intradialytic hypertension, other management strategies include lowering dialysate sodium and changing antihypertensives to include carvedilol or other poorly dialyzed antihypertensives. Hemodialysis patients with intradialytic hypertension have an increased mortality risk compared to patients with modest decreases in blood pressure during dialysis. Intradialytic hypertension is associated with extracellular volume overload in addition to acute increases in vascular resistance during dialysis. Management strategies should include reevaluation of dry weight and modification of both the dialysate prescription and medication prescription.