Bluthochdruck bei Dialysepatienten – Welcher Blutdruckwert ist relevant?

Ein hoher Blutdruck beeinflusst maßgeblich die kardiovaskuläre Morbidität und Mortalität von Patienten mit dialysepflichtiger Niereninsuffizienz. Derzeit besteht kein Konsens darüber, wie der Blutdruck dieser Patienten standardisiert gemessen und somit die Diagnose „Bluthochdruck“ sicher gestellt werden kann. Auch die mit unterschiedlichen Methoden erhobenen Blutdruckwerte können mangels fehlender Grenzwerte im Vergleich zur Normalbevölkerung bisher nicht sicher mit therapeutischer Konsequenz interpretiert werden. Dies wird durch eine U-förmige Beziehung zwischen Mortalität und Blutdruck dieser Patienten zusätzlich erschwert. Den oftmals routinemäßig nur prä- und postdialytisch erhobenen Blutdruckwerten der Patienten steht der sowohl intra- als auch interdialytische Blutdruckverlauf bei der Interpretation und Diagnosestellung erhobener Werte entgegen. So erzielt die ambulante Langzeit-Blutdruck-Messung im interdialytischen Intervall bei Verfügbarkeit die größte diagnostische und therapeutische Aussagekraft. Ziel dieser Übersichtsarbeit ist es daher, auf die unterschiedlichen Möglichkeiten und Zeitpunkte der Blutdruckmessung bei Dialysepatienten einzugehen und anhand der aktuell verfügbaren Studien eine mögliche Empfehlung für die Praxis zu geben.

Cardiovascular morbidity and mortality of hemodialysis patients is mainly influenced by high blood pressure. Currently, there is no consensus agreement about standardized measurement of blood pressure in hemodialysis patients fulfilling the need for secure diagnosis of hypertension. Lacking prescriptive limits for different blood pressure measurement methods, the acquired blood pressure values in comparison to the normal population cannot be interpreted with safe therapeutic consequence. There is also a confirmed U-shaped relationship between blood pressure and mortality among hemodialysis patients complicating the interpretation of blood pressure values. Routinely measured pre- and postdialytic blood pressure values are opposed to intra- and interdialytic blood pressure courses. If available, the interdialytic ambulatory blood pressure management for 44 or 48 hours seems to have the best diagnostic and therapeutic validity today. Therefore, the aim of this review is to focus on different possibilities and times for blood pressure measurement in hemodialysis patients in order to give a practice recommendation based on topical studies.

Key words

hypertension - hemodialysis - home blood pressure monitoring - ambulatory blood pressure monitoring

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