Iraqi Journal of Medical Sciences








Vol. 13 Issue 3 July - September / 2015
Published on website | Date : 2016-03-22 12:25:38

RESISTANT HYPERTENSION IN CHRONIC RENAL FAILURE

Jawad K. Manuti


Abstract

Background:Several factors involved in the pathogenesis of hypertension among chronic renal failure patients including sodium and water retention, increased activity of vasoconstrictive systems, decrease activity of vasodilatory systems, increased intracellular calcium, increased arterial stiffness, sleep apnea, hyperparathyroidism, erythropoietin and renovascular disease and dialysate composition and prescription.
Objective:To assess the prevalence of resistant hypertension in chronic renal failure patients and to study the relation between primary causes of renal failure, smoking, non-steroidal anti-inflammatory drugs, body mass index and hepatitis C positive with resistant hypertension.
Methods: A case-control study of five hundred patients with hypertension and on antihypertensive drugs was conducted during the period from August 2013 to December 2014. Three hundred of them are complaining chronic renal failure. All patients underwent a history and physical examination at baseline. Blood pressure measurement was done for them and blood urea, serum creatinine, serum electrolytes, hemoglobin level and random blood sugar were estimated.
Results:Patients with office blood pressure 140/90 mmHg or those treated with antihypertensive drugs are considered as hypertensive, which made up 87.9% of patients with chronic renal failure. The prevalence of resistant hypertension is 31%; all of them are receiving more than three drugs. Resistance hypertension in chronic renal failure associated with high body mass index, left ventricular hypertrophy, and symptom complaint and non-steroid anti-inflammatory drugs but not related to urea level.
Conclusion:Resistant hypertension in chronic renal failure is almost always multifactorial in etiology, may be more sensitive to sodium than the general hypertensive population. Resistance to diuretic in chronic renal failure contributes mainly to resistant hypertension.
Keywords: Hemodialysis, resistant hypertension, chronic renal failure


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