BLOOD-PRESSURE, LEFT-VENTRICULAR HYPERTROPHY AND LONG-TERM PROGNOSIS IN HEMODIALYSIS-PATIENTS

Cardiovascular events are the main cause of death in patients with chr onic renal failure who are treated with hemodialysis. Hypertension is frequent among dialysis patients and may be a major cause of mortality , although epidemiological studies are controversial in this regard. T his disparity in results may be the consequence of an inadequate defin ition of hypertension in dialysis patients as well as the interaction with hypertension with other risk factors such as malnutrition or left ventricular hypertrophy (LVH), which are strong predictors of death. Although the goal of blood pressure in dialysis has not been establish ed yet, it seems that predialysis blood pressure levels lower than 150 /90 mm Hg must be achieved for patients to avoid complications. LVH is very frequent among dialysis patients and starts early in the progres sion of chronic renal failure. Hypertension is the main cause for its development, but other potentially reversible factors such as anemia, volume overload, secondary hyperparathyroidism, dose of dialysis or ma lnutrition may also be implicated. Hence, an adequate management of pa tients on hemodialysis must include the strict control of blood pressu re, preferably with angiotensin converting enzyme (ACE) inhibitors, to gether with those early measures in order to avoid the development of the other causes of LVH or to treat them when they already exist.