高血压英文ppt精品课件significance of controlling hypertension in patients with endstage renal

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1、SignificanceofControllingHypertensioninPatientswithEnd-StageRenalDiseaseSource:HorlWH.Hypertensioninend-stagerenaldisease:Differentmeasuresandtheirprognosticsignificance.NephrolDialTransplant.2010:1–6.Bloodpressure(BP)controlmightbeanimportanttargetfortheinterventiontoreducecardio

2、vascularmortalityinthemajorityofhypertensivepatientswhostartdialysis.NoconsensusexistsastolowerincreasedBPinhemodialysis(HD)patientsortheleveltowhichBPshouldbetargeted.Inaddition,theaccurateassessmentofBPisdifficultinthispatientpopulation.NationalKidneyFoundationDiseaseOutcomesQua

3、lityInitiative(NKFKDOQI)-recommendedperidialyticBPtargetsof<140/90mmHgpredialyticand<130/80mmHgpostdialyticresultsinanincreasedfrequencyofintradialytichypotension.PeridialyticBPmeasurementsareusedforthemanagementofhypertensioninthemajorityofHDpatients.PredialysissystolicBPbetween1

4、40and160mmHgandapredialysisdiastolicBPbetween70and90mmHgisrecommendedinHDpatientstoreducetheriskofmortality.AstudyfoundthatapredialysissystolicBP<120mmHgwasassociatedwithahigherriskofmortalitycomparedwiththereferencegroupwithapredialysissystolicBPbetween140and159mmHg.Thepatternsof

5、systolicBP,diastolicBP,meanarterialpressure(MAP)andpulsepressure(PP)inHDpatientsdiffersmarkedlywiththatofthegeneralpopulation.AnincreaseinsystolicBP,diastolicBP,MAPandPPwasobservedamongyoungHDpatientsreflectinganaccelerationofcardiovasculardiseasesinthesepatients.Thissuggeststhati

6、nthissubgroupofpatients,BP-loweringtherapymaybebeneficial.Dry-WeightReductioninHypertensiveHemodialysis(DRIP)trialsupportstheuseofhomeBPmeasurementinHDpatients.After18–30hofcompletionofthedialysistreatment,homeBPmeasurementsarerecommended.IntheabsenceofhomeBPmonitoringamongHDpatie

7、nts,intradialyticBPrecordingsmayimprovethediagnosisandmanagementofhypertension.MostpatientsundergoingHDrequireanumberofantihypertensivesinordertoachievetheappropriateBP.AllclassesofantihypertensivesareusedforcontrollinghypertensioninHDpatients;however,onlyafewHDpatientsmaybenefitf

8、romloopdiuretics.Themetaanalysisb