| Theme |
Hypertension and Hypotension in Patients with Maintenance Dialysis -- Mechanisms and Therapeutic Approach |
| Title |
Strategy for antihypertensive treatment in dialysis patients |
| Author |
Hachiro Seno |
Kaikoukai Anjo Kyoritsu Clinic |
| Author |
Yasumasa Kawade |
Kaikoukai Central Clinic |
| Author |
Hirotake Kasuga |
Kaikoukai Nagoya Kyoritsu Hospital |
| Author |
Kaoru Yasuda |
Kaikoukai Nagoya Kyoritsu Hospital |
| Author |
Takanobu Toriyama |
Kaikoukai Nagoya Kyoritsu Hospital |
| Author |
Hirohisa Kawahara |
Kaikoukai Nagoya Kyoritsu Hospital |
| [ Summary ] |
Because one cause of hypertension in hemodialysis patients is volume overload, regulation and control of adequate dry-weight is important. Although the Japanese Society of Dialysis Treatment pointed out the danger of low blood pressure in their statistics, we think that it is allowable in the short run, after initiation of hemodialysis, to maintain slightly lower blood pressure, using loop diuretics or an ACE inhibitor. The dialysis method must be changed to the peritoneal type when there is critical hemodialysis difficulty. For stabilized contorol of blood pressure, a drug with a high T/P ratio is useful. ACE inhibitors are the medicine of first choice because of their organ-protective actions. ARB is used when ACE inhibitors cannot be used, or combined to aid ACE inhibitors. Ca antagonist is often used in combined therapy with ACE inhibitors. In order to avoid side effects, a long acting agent is desirable. Reservation of compliance is indispensable in order to demonstrate the effect of a medicine. |