What is hypertension
Hypertension: a clinical syndrome in which elevated arterial pressure (systolic and/or diastolic) in the body circulation is the main manifestation.
It is often accompanied by changes in the function of the heart, brain, kidneys and other vital organs, and is one of the major causes of death from cardiovascular disease.
How to diagnose hypertension
Non-same day, 3 times resting blood pressure exceeds 140/90mmHg
How to measure blood pressure: “three same principle”
Same time
Same state
Same side
Hypertension is all around you and me
The number of hypertensive patients in China has reached 160 million, with an annual increase of more than 3 million people;
In China, every third family has a patient with hypertension;
More than 80% of uremic patients have hypertension before starting hemodialysis, and most of them still fail to control their blood pressure after hemodialysis.
The majority of patients do not have effective blood pressure control
The symptoms of hypertension are complex and varied
Symptoms: Some patients are asymptomatic, with only fluctuating blood pressure and blood pressure. Some patients develop neurological-like symptoms such as dizziness, headache, fatigue, forgetfulness, tinnitus, and sleeplessness. Some patients develop complications before they are detected.
What are the causes that can lead to hypertension in dialysis patients?
Genetic factors ;
Geographical-climatic influences ;
Excess water in the body ;
Activation of the renin-angiotensin-aldosterone system;
Uremic toxins;
Correction of anemia with erythropoietin;
Parathyroid hormone (PTH) elevation;
Impaired endothelin-dependent vasodilation;
Salt intake/dialysis fluid salt concentration;
Dialysis prescription;
Why does adequate water removal from dialysis and adequate antihypertensive medication still fail to control blood pressure?
1. High parathyroid hormone is one of the causes of hypertension in dialysis patients
The abnormally elevated parathyroid hormone PTH in uremic patients increases small arterial tension and raises peripheral vascular resistance, resulting in a rise in blood pressure.
PTH also stimulates vascular smooth muscle cell hypertrophy, leading to vessel wall thickening and hypertension.
2. Asymmetric dimethylhydroxyarginine (ADMA): a risk factor for hypertension
ADMA reduces the production of diastolic substances (NO).
Plasma ADMA can also narrow the lumen of blood vessels and increase intravascular forces leading to hypertension.
Increased ADMA is a sign of endothelial dysfunction and is a potential risk factor for hypertension.
3. The use of erythropoietin (EPO) can also lead to hypertension.
General tests related to hypertension
Blood, urine routine, kidney function, blood lipids, blood sugar, electrolytes, ECG, chest X-ray, echocardiogram, fundus changes.
Treatment of dialysis hypertension-improvement of life behavior
1. Limit foods high in sodium. Salted vegetables, canned food, cooked food (sausage, ham, etc.). Salt, monosodium glutamate, soy sauce, umami vinegar, chili sauce, bean paste, salad dressing, ketchup, oyster sauce, tempeh, etc. used in cooking. Instant noodles and other instant food.
2, limit animal fats and deep-fried foods, such as fatty pork, fried chicken legs, etc.
Dialysis hypertension patients are often treated with a combination of drugs
What is refractory hypertension
Uremic patients with adequate dialysis water removal adequately and appropriately, and adequate combined use of three or more antihypertensive drugs is still higher than 140/90mmHg, called uremic refractory hypertension.
How to manage refractory hypertension.
Combined artificial kidney treatment
1.For patients with primary hypertension, combined artificial kidney therapy may have less than ideal blood pressure lowering.
2. For patients who cannot adequately remove water, combined artificial kidney therapy often does not have a significant effect on lowering blood pressure.