Risikofaktor Hypertonie bei Dialysepatienten – Konkrete Antworten zu Blutdruckzielwerten und zur Therapie fehlen

Eine Hypertonie bei Patienten mit terminaler Dialysepflicht hat einen wesentlichen Effekt auf die kardiovaskuläre Morbidität und Mortalität. Neben klassischen Risikofaktoren sind beim Dialysepatienten auch sogenannte nicht traditionelle Risikofaktoren von Bedeutung. Hervorzuheben ist die Störung des Volumenhaushalts. Nicht selten beobachtet man bei den Patienten einen sehr hohen systolischen und eher niedrigen diastolischen Druck. Dies ist ein Ausdruck der erhöhten Gefäßsteifigkeit als Folge einer akzelerierten Arteriosklerose. In der Therapie sollte der Patient vor der Dialyse einen Blutdruck von unter 140/90 mmHg erreichen, wobei klare Grenzwerte bisher nicht durch Studien an Dialysepatienten gezeigt wurden. Die Blutdruckeinstellung erfolgt zum einen durch eine medikamentöse Therapie, dabei spielen Hemmer des Renin-Angiotensin-Systems, Kalziumkanalblocker und Betablocker eine wichtige Rolle. Zum anderen ist eine optimierte Volumen- und Kochsalzkontrolle des Patienten enorm wichtig, wobei er ein optimales Trockengewicht erreichen sollte. Leider gibt es bisher nur wenige systematische und zum Teil nur kleine Studien, die Grenzwerte für die Hypertonie, die optimierte Volumenregulation oder die medikamentöse Therapie klar definieren.

The prevalence of hypertension in patients with end-stage renal disease (ESRD) is a very common problem. It is very well-defined that hypertension has a large impact on the high cardiovascular mortality and morbidity risk in these patients. Besides the classical risk factors for the pathogenesis of hypertension, non-traditional risk factors play a prominent role. Especially disturbances of volume and sodium regulation in these patients are problematic. Very often, high systolic and low diastolic pressures in patients with ESRD are measured. This is a typical consequence of the accelerated arteriosclerosis which occurs as a consequence of ESRD. It is assumed that a blood pressure of below 140/90 mmHg should be achieved before hemodialysis sessions. Currently, there are no study-based hypertension guidelines especially for the hemodialysis population, as most information taken for these patients come from studies which were performed in hypertensive patients without concomitant renal disease. To control blood pressure in ESRD patients, a combined approach of the use of medications and regulation of volume and salt consumption is used. Especially the optimal control of the „dry-weight” in these patients is necessary. Unfortunately, there are only very few and typically small studies which investigate optimal volume control and drug-based therapy of hypertension in ESRD patients. But it is clearly evident that treatment of hypertension in ESRD patients is essential to reduce high cardiovascular risk in these patients.

Key words

hemodialysis - hypertension - therapy - ESRD patients

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