Hypertension in Dialysis Patients

The link between hypertension, left ventricular hypertrophy, heart failure, and sudden death is clear. In the dialysis population, persistent hypertension is observed in the majority of patients, making it a fundamental and unmet challenge. Accumulating evidence shows that ambulatory blood pressure is a better predictor of survival than in-unit blood pressure—and, importantly, that ambulatory blood pressure is linearly associated with risk of cardiovascular events.1,2

As clinicians, how should we respond to this challenge? A recent European consensus statement, published in the Journal of Hypertension, offers insights.3

The article outlined the diagnosis, epidemiology, pathogenesis, and treatment of hypertension in patients on dialysis. The authors emphasized the need to focus on correcting the primary mechanisms of hypertension: sodium and volume excess.

Hypertension In Dialysis Patients Recent Findings

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Non-pharmacological strategies to reduce blood pressure were suggested as initial therapeutic approaches, specifically3:

  • Reduce salt intake
  • Individualize dialysate sodium
  • Increase treatment length and frequency

As multiple randomized clinical trials have reported, patients assigned to longer or more frequent dialysis regimens achieve better BP control, with reduced dependence on antihypertensive medications.

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  1. Agarwal R. Blood pressure and mortality among hemodialysis patients. Hypertension. 2010 Mar; 55(3):762-768.
  2. Bansal N, et al. Blood pressure and risk of cardiovascular events in patients on chronic hemodialysis: the CRIC study (Chronic Renal Insufficiency Cohort). Hypertension. 2017 Aug; 70(2):435-443.
  3. Sarafidis PA, et al. A consensus document by the EURECA-m working group of the ERA-EDTA and the Hypertension and the Kidney working group of the ESH. Journal of Hypertension. 2017 Apr; 35(4):657-676.