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Article
Hypertension in Haemodialysis

Author: Jawad K. Manuti
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 3 Pages: 225-228
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Relevant factors involved in the pathogenesis of hypertension among dialysis patients include sodium and water retention, dialysate composition and prescription, increased activity of vasoconstrictive systems(sympathetic nervous system, rennin-angiotensin system, endothelin and vasopressin), decrease activity of vasodilatory systems(nitric oxide, kinins), increased intracellular calcium, increased arterial stiffness, sleep apnea, hyperparathyroidism, erythropoietin and renovascular diseaseOBJECTIVE:The objective of this study is to assess the prevalence of hypertension among uremic patients undergoing haemodialysis and to assess difference of blood pressure reading before and after dialysis.PATIENTS AND METHODS:140 patients with chronic renal failure &acute renal failure on regular haemodialysis. blood pressure was measured by doctors before dialysis, within 2 hour of dialysis , after dialysis and after 48 hours of dialysis. we averaged six routine predialysis systolic and diastolic blood pressure. The same was carried out for postdialysis.RESULTS:Patients with preheamodialysis (office BP) >130/85 mmHg are considered as hypertensive in chronic renal failure, who made up of 74% of the study population. 40% patients were on monotherapy antihypertensive drug. 65% are taking calcium channel blocker, angiotensin converting enzyme inhibitor 38%, angiotensin П receptor blockers 26% and beta blocker 20%. Preheamodialysis blood pressure(Office BP) overestimated BP values in relation to 48 h postdialysisCONCLUSION:Significant difference was shown between predialysis office blood pressure and 48 hour postdialysis in the recognition of hypertension in heamodialysis patients. the prevalence of hypertension in heamodialysis patients is high (74%). most of the patients used combination of antihypertensive drugs, calcium channel blocker commonly used 65%.


Article
Inter-arm Blood Pressure Difference in Type 2 Diabetic Patients and Ambulatory Blood Pressure Monitoring :A Clinical Dilemma

Author: Hassan Salim Abdulsada
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2015 Volume: 8 Issue: 2 Pages: 2240-2251
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Frequently coexistent condition in type 2 diabetes mellitus is hypertension and vice versa. Measurement of blood pressure by ambulatory blood pressure monitoring is superior to ordinary blood pressure . Blood pressure disparity reflects vascular diseases which diabetic patients liable for. Inconsistency in selecting the proper arm for blood pressure measurement may create a clinical dilemma in the presence of systolic and/or diastolic disparity.Aim :We tried in this study to set proper steps in choosing the suitable arm for ambulatory blood pressure monitoring cuff fitting.Material and Methods :Consecutive 140 type 2 diabetes mellitus patients aged 29 years and elder were examined by sequential ordinary blood pressure and simultaneous dual ambulatory blood pressure monitoring.Results: Systolic disparity grade I was dominant (75.7%) as well as diastolic disparity grade I (86.4%). The mean systolic and diastolic blood pressure in the dominant arm was higher than that in the non-dominant arm with significant pressure differences (<0.001).Age and duration of diabetes had positive impacts on systolic and diastolic disparities while gender and Hemoglobin A1C had no impacts. Systolic and diastolic blood pressures were significantly different in both arms when studied over day-time, night-time, and 24-hours ambulatory monitoring. Systolic and diastolic differences in the dominant arm and the non-dominant arm had been shown to have significant mean differences with the mean ambulatory day-time blood pressure.Discussion: Sequential method is an accepted modality and the arm with the higher systolic and/or diastolic blood pressure is the suitable arm for ambulatory monitoring and generally mirroring OBP

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