Prevalence and factors associated with uncontrolled blood pressure in dialysis patients using antihypertensive: a narrative review
Abstract
Hypertension in patients with end-stage chronic kidney disease undergoing hemodialysis is difficult to control leading to a significant risk factor for a cardiovascular event. The aimed of this review is to summarize the prevalence of uncontrolled blood pressure in dialysis patients. This review hopefully can serve as a valuable reference and source of insight for clinicians in their efforts to attain controlled blood pressure in dialysis patients. The relevant literatures was undertaken from PubMed, Scopus, and Google Scholar for studies addressing the factor associated with uncontrolled blood pressure in hemodialysis patients using antihypertensives from 2013 to 2023. Combinations of search terms were "uncontrolled" and "blood pressure" and "dialysis" and "antihypertensive”. Any study in English, including randomized control trials, cohort, case-control, and cross-sectional studies was included. Uncontrolled blood pressure is very common among hypertension in dialysis patients (28.7 - 78.33% of cases). Factors affecting blood pressure in dialysis patients include age, obesity, and comorbidity (diabetes and stage of chronic kidney disease). Although the relationship between gender, the number of antihypertensive, the number of dialysis, and the length of dialysis sessions with blood pressure varies, some studies have shown a positive association.
References
K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 2005; 45(4 Suppl 3):S1-153.
Agarwal R, Flynn J, Pogue V, Rahman M, Reisin E, Weir MR. Assessment and management of hypertension in patients on dialysis. J Am Soc Nephrol 2014; 25(8):1630-46.
https://doi.org/10.1681/ASN.2013060601
Georgianos PI, Agarwal R. Blood pressure and mortality in long-term hemodialysis—time to move forward. Am J Hypertens 2016; 30(3):211-22.
https://doi.org/10.1093/ajh/hpw114
Bucharles SGE, Wallbach KKS, Moraes TP, Pecoits-Filho R. Hypertension in patients on dialysis: diagnosis, mechanisms, and management. J Braz Nephrol 2019; 41(3):400-11.
https://doi.org/10.1590/2175-8239-jbn-2018-0155
Ohta Y, Kanesaki M, Tsuruta H, Nosaka H, Nakamura H, Kawano Y. Blood pressure control status in dialysis patients. J Hypertens 2019; 37:e260.
https://doi.org/10.1097/01.hjh.0000573324.74660.02
Nugraha IKA, Tedjamartono TD, Sunaka W. Factors associated with blood pressure in end stage renal disease patients receiving regular hemodialysis at Wangaya General Hospital, Denpasar. Int J Adv Med 2021; 8(8):1201.
https://doi.org/10.18203/2349-3933.ijam20212867
Al-Ramahi R, Amr R. Prevalence of uncontrolled hypertension in hemodialysis patients: a cross-sectional study from Palestine. Palestinian Med Pharma J 2023; 8(2):123-32.
https://doi.org/10.59049/2790-0231.1166
Sarafidis PA, Mallamaci F, Loutradis C, Ekart R, Torino C, Karpetas A, et al. Prevalence and control of hypertension by 48-h ambulatory blood pressure monitoring in haemodialysis patients: a study by the European Cardiovascular and Renal Medicine (EURECA-m) working group of the ERA-EDTA. Nephrol Dial Transplant 2019; 34(9):1542-8.
https://doi.org/10.1093/ndt/gfy147
Al Sahlawi M. Blood pressure control among patients with chronic kidney disease in Saudi Arabia: a single-center experience. Arterial Hypertension 2023; 27(2):73-7.
https://doi.org/10.5603/AH.a2023.0010
Burmeister JE, Mosmann CB, Costa VB, Saraiva RT, Grandi RR, Bastos JP, et al. Prevalence of cardiovascular risk factors in hemodialysis patients - The CORDIAL Study. Arq Bras Cardiol 2014; 102(5):473-80.
https://doi.org/10.5935/abc.20140048
Mallamaci F, Torino C, Sarafidis P, Ekart R, Loutradis C, Siamopoulos K, et al. Treatment-resistant hypertension in the hemodialysis population: a 44-h ambulatory blood pressure monitoring-based study. J Hypertens 2020; 38(9):1849-56.
https://doi.org/10.1097/HJH.0000000000002448
Bakri TK, Akmal R, Vonna A, Desiyana LS, Sari F. Correlation between adherence of antihypertensive drugs use and blood pressure control in patients with esrd undergoing hemodialysis. BIOLINK 2022; 8(2):229-41.
https://doi.org/10.31289/biolink.v8i2.6028
Li D, Huo Z, Liu D, Gong N, Zhang F, Kong Y, et al. Current apparent treatment‐resistant hypertension in patients undergoing peritoneal dialysis: a multi‐center cross‐sectional study. J Clin Hypertens 2022; 24(4):493-501.
https://doi.org/10.1111/jch.14455
Gulalai, Ahmad N, Wahid A, Khan A, Atif M, Khan A. Evaluation of management and factors associated with hypertension control in hemodialysis patients at a tertiary-care hospital in Pakistan. Drugs Therapy Perspect 2020; 36(1):396-403.
https://doi.org/10.1007/s40267-020-00763-5
Shwaib H, Elhassan M, Mohamed A, Sayed HE, Haider M, Abdellateef M, et al. Age specific prevalence of hypertension, socio-demographic and behavioral characteristics of end stage renal disease patients on regular haemodiaysis in a developing a country. J Hypertens 2016; 34(Supplement 1):e306.
https://doi.org/10.1097/01.hjh.0000500743.57625.93
Tanaka S, Ninomiya T, Hiyamuta H, Taniguchi M, Tokumoto M, Masutani K, et al. Apparent treatment-resistant hypertension and cardiovascular risk in hemodialysis patients: ten-year outcomes of the Q-Cohort study. Sci Rep 2019; 9(1):1043.
https://doi.org/10.1038/s41598-018-37961-1
Kotanko P, Garg AX, Depner T, Pierratos A, Chan CT, Levin NW, et al. Effects of frequent hemodialysis on blood pressure: Results from the randomized frequent hemodialysis network trials. Hemodial Int 2015; 19(3):386-401.
https://doi.org/10.1111/hdi.12255
Kauric-Klein Z. Depression and medication adherence in patients on hemodialysis. Curr Hypertens Rev 2018; 13(2):138-43.
https://doi.org/10.2174/1573402113666171129182611
Kauric-Klein Z. Factors affecting blood pressure control in hemodialysis. J Hypertens Open Access 2013; 02(02).
https://doi.org/10.4172/2167-1095.1000113
Huang B, Li Z, Wang Y, Xia J, Shi T, Jiang J, et al. Effectiveness of self‐management support in maintenance haemodialysis patients with hypertension: a pilot cluster randomized controlled trial. Nephrology 2018; 23(8):755-63.
https://doi.org/10.1111/nep.13098
Noghan N, Akaberi A, Pournamdarian S, Borujerdi E, Sadat Hejazi S. Resilience and therapeutic regimen compliance in patients undergoing hemodialysis in hospitals of Hamedan, Iran. Electron Physician 2018; 10(5):6853-8.
Halle MP, Nelson M, Kaze FF, Jean Pierre NM, Denis T, Fouda H, et al. Non-adherence to hemodialysis regimens among patients on maintenance hemodialysis in sub-Saharan Africa: an example from Cameroon. Ren Fail 2020; 42(1):1022-8.
https://doi.org/10.1080/0886022X.2020.1826965
Clark-Cutaia MN, Ren D, Hoffman LA, Burke LE, Sevick MA. Adherence to hemodialysis dietary sodium recommendations: influence of patient characteristics, self-efficacy, and perceived barriers. J Ren Nutr 2014; 24(2):92-9.
https://doi.org/10.1053/j.jrn.2013.11.007
Khan A, Khan AH, Adnan AS, Sulaiman SAS, Mushtaq S, Ahmad N, et al. Hypertension control among euvolemic hypertensive hemodialysis patients in Malaysia: a prospective follow-up study. J Pharm Policy Pract 2019; 12(1):10.
https://doi.org/10.1186/s40545-019-0169-y
Mechta Nielsen T, Frøjk Juhl M, Feldt-Rasmussen B, Thomsen T. Adherence to medication in patients with chronic kidney disease: a systematic review of qualitative research. Clin Kidney J 2018; 11(4):513-27.
https://doi.org/10.1093/ckj/sfx140
Daud R, Zulkarnain BS, Amu IV. Providing counseling through home pharmacy care (HPC) for hemodialysis patients with hypertension in lowering blood pressure. J Basic Clin Physiol Pharmacol 2021; 32(4):459-65.
