| Theme |
Metabolic Syndrome in Chronic Renal Failure |
| Title |
Significance and medical treatment of hypertension in hemodialysis (HD) patients with metabolic syndrome |
| Author |
Atsuhiro Yoshida |
Department of Internal Medicine and Pathophysiology, Nagoya City University, Graduate School of Medical Sciences |
| Author |
Genjiro Kimura |
Department of Internal Medicine and Pathophysiology, Nagoya City University, Graduate School of Medical Sciences |
| [ Summary ] |
Blood pressure control is significantly important in hemodialysis (HD) patients. However, the relationship between blood pressure (BP) and long term mortality in HD patients has remained controversial. Recently, some authors have reported that pulse pressure was a more potent predictor of total mortality than systolic BP or diastolic BP in non-diabetic patients. Other authors reported intradialysis hypotension and orthostatic hypotension after HD therapy were significant factors affecting mortality in HD patients. These results suggested lower pre-HD BP and stabilized intra-HD BP were important in HD patients.
Many studies strongly suggested angiotensin II was a contributing factor at every step in the metabolic domino process and renin-angiotensin (RA) blockage was useful to prevention of these processes. We believe that RA blockers are key drugs for patients with metabolic syndrome. Recently, some studies have reported that telmisartan had a greater potential than other RA blockers to activate PPAR γ, which is strongly linkage to metabolic syndrome. Since telmisartan activates both the PPAR γ pathway and suppresses RA system, it is the first choice for hypertensive patients with metabolic syndrome. |