Hypertension in renal insufficiency

Abstract

Hypertension and a high incidence of cardiovascular morbidity and mortality often accompany end-stage renal disease. Causes of the hypertension include abnormalities of extracellular fluid volume, increased activity of the renin-angiotensin system, dysfunction of the autonomic nervous system, and deficiency of vasodilator substances. Treatment is not detrimental to residual renal function and may enhance the quality of survival. Several types of therapy are available that may be used sequentially or in combination. New antihypertensive drugs and improved blood-cleansing devices allow a more optimistic outlook on long-term survival in end-stage renal disease.

Exercise Training Improves Hypertension in Hemodialysis Patients

“…Those who remain hy pertensive after adequate ultrafiltration frequently re quire drug therapy and have abnormalities in either the renin-angiotensin system or the autonomic nervous sys tem [5], The dialysis patients who participated in this study had been on hemodialysis and on a stable dialysis and medication regimen for at least 6 months prior to participation in the training program. While it is unlikely that such a substantial reduction in antihypertensive medications, in combination with this decrease in blood pressure, could have been caused entirely by a decrease in their plasma volumes, this possibility cannot be excluded without the measurement o f blood volume.…”

“…Hypertension and coronary heart disease appear to be causally related in both uremic and nonuremic patients [1][2][3][4], The reduction of blood pressure by pharmacologi cal means frequently reduces cardiovascular mortality in both types of patients [2][3][4], The initiation o f hemodialy sis and ultrafiltration normalizes blood pressure in most uremic patients [1], but not in those with abnormalities in the renin-angiotensin system or autonomic dysfunction [5], Antihypertensive medications help to normalize blood pressure in persistently hypertensive dialysis pa tients [6], but drug side effects and poor patient com pliance have led to the search for nonpharmacologic methods for reducing blood pressure [7]. Endurance exer cise training lowers blood pressure in some hypertensive and borderline hypertensive nonuremic individuals [8][9][10][11], but its effect in hypertensive dialysis patients has not been examined.…”

Efectos del prazosin sobre el control de la presión arterial en hipertensos sometidos a diálisis

“…Los enfermos del segundo grupo tuvieron concentración normal o moderada mente mayor de renina, pero la presión arterial no reaccionó a la ultrafiltración. Se considera que estos pacientes tienen defectos en la regulación del sistema autónomo, que originan el estado de hipertensión (11,14). La posibilidad de que falte una substan cia vasodilatadora producida generalmente por los riñones, no ha sido comprobada (11).…”

“…Se considera que estos pacientes tienen defectos en la regulación del sistema autónomo, que originan el estado de hipertensión (11,14). La posibilidad de que falte una substan cia vasodilatadora producida generalmente por los riñones, no ha sido comprobada (11). El tipo menos frecuente de hipertensión guarda relación con concentración plasmática muy alta de renina, y en estos casos resulta muy difícil controlar la presión arterial (6).…”

“…Recientemente, se ha descrito un tercer grupo que incluye hipertensos que no son " volumen-sensibles" ni presentan renina alta. Se considera que en estos sujetos el estado hipertensivo depende de la disfunción del sistema nervioso autónomo (11,12).…”