ion, the prevalence of apparent treatment-resistant hypertension is estimated to be between 18% and 42%. Owing to the lack of a rigorous assessment of some common causes of pseudoresistance, the burden of true resistant hypertension in the dialysis population remains unknown. What distinguishes apparent treatment-resistance from true resistance is white-coat hypertension and adherence to medications. Accordingly, the diagnostic workup of a dialysis patient with apparent treatment-resistant hypertension on dialysis includes the accurate determination of BP control status with the use of home or ambulatory BP monitoring and exclusion of nonadherence to the prescribed antihypertensive regimen. In a patient on dialysis with inadequately controlled BP, despite adherence to therapy with maximally tolerated doses of a β-blocker, a long-acting dihydropyridine calcium channel blocker, and a renin-angiotensin system inhibitor, volume-mediated hypertension is the most important treatable cause of resistance. In daily clinical practice, such patients are often managed with intensification of antihypertensive therapy. However, this therapeutic strategy is likely to fail if volume overload is not adequately recognized or treated. Instead of increasing the number of prescribed BP-lowering medications, we recommend diet and dialysate restricted in sodium to facilitate achievement of dry weight. The achievement of dry weight is facilitated by an adequate time on dialysis of at least 4 hours for delivering an adequate dialysis dose. In this article, we review the epidemiology, diagnosis, and management of resistant hypertension among patients on dialysis....

中文翻译：

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透析中的难治性高血压：流行病学、诊断和治疗

据估计，明显难治性高血压的患病率在 18% 至 42% 之间。由于缺乏对假性耐药的一些常见原因的严格评估，透析人群中真正的难治性高血压的负担仍然未知。区分表观治疗耐药性和真正耐药性的是白大衣高血压和药物依从性。因此，对透析时明显难治性高血压的透析患者的诊断检查包括使用家庭或动态血压监测准确确定血压控制状态，并排除不遵守规定的抗高血压方案的情况。对于血压控制不佳的透析患者，尽管坚持使用最大耐受剂量的β受体阻滞剂、长效二氢吡啶钙通道阻滞剂和肾素血管紧张素系统抑制剂进行治疗，容量介导的高血压是最重要的可治疗药物抵抗的原因。在日常临床实践中，此类患者通常通过强化抗高血压治疗进行治疗。然而，如果容量超负荷没有得到充分认识或治疗，这种治疗策略可能会失败。我们建议限制饮食和透析液中的钠含量，以促进达到干体重，而不是增加处方降压药物的数量。至少 4 小时的充足透析时间以提供足够的透析剂量，有助于实现干重。在本文中，我们回顾了透析患者中​​难治性高血压的流行病学、诊断和治疗......