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HEMODİYALİZ HASTALARINDA HİPERTANSİYON SIKLIĞI VE VOLÜM KONTROLÜNÜN ÖNEMİ

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PREVALANCE OF HYPENTENSION IN HEMODIALYSIS PATIENTS AND THE IMPORTANCE OF VOLUME CONTROL

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32-35

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Abstract (Original Language): 
Hemodiyaliz, (HD) hastalarında hipertansiyona (HT) sık rastlanmakta olup, bu hastalarda HTkardiovasküler morbidite ve mortaliteyi artıran en önemli faktördür. Biz bu çalışmada, HD ünitemizde Nisan 1999da, hemodiyalize girmekte olan toplam 57 (28 K, 29 E) hastada hipertansiyon ( >140/90 mmHg ) sıklığını ve bir yıl süreli sıkı volüm kontrolü uygulamasının kan basıncı düzeylerine etkisini araştırdık. Nisan 1999da hastaların yaklaşık yarısı (% 49.1 'i) antihipertansif ilaç kullanmasına rağmen, üçte biri (%33) halen hipertansifti. Bu hastalarda aşırı interdiyalitik kilo artışı (%4.5) olduğu gözlendi. Hastalara sıkı tuz kısıtlamasına ilaveten diyaliz hipotansiyonu oluşana dek tedrici ultrafiltrasyon uygulamasına geçildi. Volüm kontrolü ile kan basıncı düşen hastaların antihipertansif ilaçları tedrici olarak kesildi. Bu uygulama ile bir yılın sonunda; sistolik ve diastolik kan basınçlarında önemli azalma [sırasıyla 134.5+24.9 mmHgdan 125.8+18.0 mmHg'ya (p=0.005) ve 79.3+15.9 mmHgdan 76.1 ±11.7 mmHg'ya (p= 0.067)] gözlendi ve hipertansiyon sıklığının % 5.3'e düştüğü tespit edildi. Sonuç olarak, sıkı ultrafiltrasyon uygulaması ile volüm kontrolü sağlanan hastaların çoğunda kan basıncının kontrol altına alındığı tespit edildi. Bu nedenle HD hastalarında, antihipertansif ilaç başlamadan evvel sıkı volüm kontrolü ile gerçek kuru ağırlığa ulaşılması öncelikli hedef olmalıdır.
Abstract (2. Language): 
Hypertension (HT) is very common in hemodialysis (HD) patients, and this is the most important factor that increase cardiovascular morbidity and mortality. In this study, we determimined theprevalance ofHT ( 2140/90 mmHg) and the effect of one year strict volume control on blood pressure levels in 57 patients (28 females, 29 'males) undergoing HD in our HD unit since April 1999. Although almost half of the patients (49.1%) were taking antihypertensive drugs, 33 percent of them were still hypertensive on April 1999. These patients had a greater interdialytic weight gain (4.5%). In addition to strict salt restriction, persistent ultrafiltration was applied until achieving dialysis hypotension. Antihypertensive drugs of the patients whose blood pressure reduced with volume control were discontinued gradually. With this procedure, systolic and diastolic blood pressure levels significantly reduced (from 134.5+24.9 mmHg to 125.8+18.0 mmHg, p=0.005 and form 79.3+15.9 mmHg to 76.1+11.7 mmHg, p=0.067, respectively) and the prevalence of HT was decreased to 5.3% at the end of one year period. We concluded that normal blood pressure levels could be reached in most of the patients with strict volume control by ultrafiltration. Therefore, before starting antihypertensive drug treatment the real dry weight should be achieved by strict volume control in HD patients.

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