关键词: 高血压, 维持性血液透析, 机制, 防治

Abstract: 【Abstract】Hypertension is a very common clinical problem in hemodialysis, which is closely related to cardiovascular events and high mortality in maintenance hemodialysis (MHD) patients. Mechanism underlying the hypertension is very complex, and volume overload is thought to be the major cause. However, some MHD patients are still suffering from refractory hypertension at the condition that excessive blood volume has been well controlled by adequate dialysis. There are many other factors involved in the hypertension, such as increased activity of sympathetic nervous system or renin-angiotensin system (RAAS), use of erythropoietin, imbalance of systolic and diastolic blood factors, etc. Recently, endothelin-1, parathyroid hormone, Na+, K+-ATP enzyme inhibitors, Ca2+, etc. were also related to the hypertension. In addition, intradialytic hypertension may play an important role in refractory hypertension in MHD. The strategies for prevention and treatment of hypertension in MHD patients include appropriate assessment and maintenance of dry weight, salt-intake control and adequate hemodialysis to control volume load. In addition, some comprehensive measures can be taken into account to control the hypertension, such as suppression of sympathetic activity, inhibition of endothelin release, combined use of antihypertensive drugs, adjustment of erythropoietin, and modulation of dialysis mode.

Key words: Hypertension, Maintenance hemodialysis, Mechanism, Prevention and treatment