{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:27:15Z","timestamp":1788280035672,"version":"build-2803163510"},"reference-count":46,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,8,28]],"date-time":"2019-08-28T00:00:00Z","timestamp":1566950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"VA Merit Review","award":["5I01CX000829-04"],"award-info":[{"award-number":["5I01CX000829-04"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Seminars in Dialysis"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Hypertension among patients on hemodialysis is predominantly systolic (either isolated or combined with diastolic hypertension), whereas the scenario of isolated diastolic hypertension is rare and more common in younger patients. Uncontrolled hypertension that persists despite aggressive antihypertensive drug therapy is a reflection of the volume overload that is a prominent mediator of systolic and diastolic BP elevation. Clinical\u2010trial evidence supports the notion that dry\u2010weight probing is an effective strategy to improve BP control, even when overt clinical signs and symptoms of volume overload are not present. Accelerated arterial stiffness influences the patterns and rhythms of interdialytic ambulatory BP and is a major determinant of isolated systolic hypertension in hemodialysis. Posthoc analyses of the Hypertension in Hemodialysis patients treated with Atenolol or Lisinopril (HDPAL) trial, however, suggest that arterial stiffness does not make hypertension more resistant to therapy and is unable to predict the treatment\u2010induced improvement in left ventricular hypertrophy. A combined strategy of sodium restriction, dry\u2010weight adjustment, and antihypertensive medication use was effective in improving ambulatory BP control regardless of the severity of underlying arteriosclerosis in HDPAL. Other nonvolume\u2010dependent mechanisms, such as erythropoietin use, appear to be also important contributors and should be taken into consideration, particularly in younger hemodialysis patients with diastolic hypertension. In this article, we explore the role of volume overload, arterial stiffness, and erythropoietin use as causes of systolic vs diastolic hypertension in patients on hemodialysis. We conclude with clinical practice recommendations and with a call for a \u201cvolume\u2010first\u201d approach when managing hemodialysis hypertension.<\/jats:p>","DOI":"10.1111\/sdi.12837","type":"journal-article","created":{"date-parts":[[2019,8,29]],"date-time":"2019-08-29T04:08:13Z","timestamp":1567051693000},"page":"507-512","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Systolic and diastolic hypertension among patients on hemodialysis: Musings on volume overload, arterial stiffness, and erythropoietin"],"prefix":"10.1111","volume":"32","author":[{"given":"Panagiotis I.","family":"Georgianos","sequence":"first","affiliation":[{"name":"Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital Aristotle University of Thessaloniki Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2016.129"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.0000154895.18269.67"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(99)70188-5"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.1998.00005.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.109.144899"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.02250507"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-1755.2005.00527.x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.117.09091"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.114.04334"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.01891105"},{"issue":"3","key":"e_1_2_7_12_1","first-page":"211","article-title":"Blood pressure and mortality in long\u2010term hemodialysis\u2010time to move forward","volume":"30","author":"Georgianos PI","year":"2017","journal-title":"Am J Hypertens"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(03)00366-8"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.2001.00997.x"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5000145"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.108.125674"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.109.136366"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.107.091579"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.02920608"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.03650807"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.03890416"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1159\/000331067"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.09321010"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2012.12.017"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2019.02.018"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2015060617"},{"issue":"5","key":"e_1_2_7_27_1","first-page":"S45","article-title":"Wave travel and reflection in the arterial system","volume":"17","author":"O'Rourke MF","year":"1999","journal-title":"J Hypertens Suppl"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.114.04587"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.18.2434"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.2174\/15701611113119990147"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00575.2007"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2015.01.018"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gft515"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0135457"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfx324"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/0272-6386(95)90492-1"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.1999.00531.x"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1081\/JDI-100100885"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1997.254"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1159\/000168267"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/0895-7061(95)00035-N"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(93)90151-E"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1993.142"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/13.11.2877"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1992.376"},{"issue":"1","key":"e_1_2_7_46_1","first-page":"E113","article-title":"Role of nitric oxide resistance in erythropoietin\u2010induced hypertension in rats with chronic renal failure","volume":"271","author":"Vaziri ND","year":"1996","journal-title":"Am J Physiol"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/3.12.947"}],"container-title":["Seminars in Dialysis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fsdi.12837","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/sdi.12837","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/sdi.12837","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/sdi.12837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T20:33:52Z","timestamp":1694205232000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/sdi.12837"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,28]]},"references-count":46,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1111\/sdi.12837"],"URL":"https:\/\/doi.org\/10.1111\/sdi.12837","archive":["Portico"],"relation":{},"ISSN":["0894-0959","1525-139X"],"issn-type":[{"value":"0894-0959","type":"print"},{"value":"1525-139X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,28]]},"assertion":[{"value":"2019-08-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}