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Nephrol Dial Transplant (2001) 16: 469-474
© 2001 European Renal Association-European Dialysis and Transplant Association

Controversy

Controversy on optimal blood pressure on haemodialysis: normotensive blood pressure values are essential for survival

Michael Schömig, Antje Eisenhardt and Eberhard Ritz

Department of Internal Medicine, Ruperto Carola University, Heidelberg, Germany

Introduction

Gérard London, our close friend and a distinguished investigator, argues that blood pressure (BP) values somewhat above the normal range are optimal for survival of patients on maintenance haemodialysis. We strongly disagree on this point and provide arguments that, despite the opinion of prominent investigators in this field, available evidence is in favour of the idea that BP values in the normotensive range are optimal for survival. We acknowledge, however, that definite controlled evidence is not yet available. In the absence of such evidence, clinicians must rely on a very powerful, although very rarely used instrument, i.e. clinical common sense.

Which BP values are considered optimal in the individual without renal disease?

It is of interest that the concept of what constitutes hypertensive BP values has been considerably revised downward in past decades. Originally, hypertension was considered to be BP >160/95 mmHg, but it was realized from the very beginning that the choice of any threshold is arbitrary, since BP readings in . . . [Full Text of this Article]

Which BP values are found in haemodialysis patients?

Which mechanisms are responsible for elevated BP in patients with renal failure?

Early observations

What is the relationship between BP and survival in dialysed patients?

The potential effect of confounding factors and reverse causality

The time factor

What is optimal BP in the individual dialysis patient and how can this be achieved?

What is a sensible practical approach?

Notes

References


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