Pharmacotherapy of hypertension in chronic dialysis patients

Panagiotis I. Georgianos, Rajiv Agarwal

Research output: Contribution to journalReview article

10 Citations (Scopus)

Abstract

Among patients on dialysis, hypertension is highly prevalent and contributes to the high burden of cardiovascular morbidity and mortality. Strict volume control via sodium restriction and probing of dry weight are first-line approaches for the treatment of hypertension in this population; however, antihypertensive drug therapy is often needed to control BP. Few trials compare head-to-head the superiority of one antihypertensive drug class over another with respect to improving BP control or altering cardiovascular outcomes; accordingly, selection of the appropriate antihypertensive regimen should be individualized. To individualize therapy, consideration should be given to intra- and interdialytic pharmacokinetics, effect on cardiovascular reflexes, ability to treat comorbid illnesses, and adverse effect profile. b-Blockers followed by dihydropyridine calcium-channel blockers are our first- and second-line choices for antihypertensive drug use. Angiotensin–converting enzyme inhibitors and angiotensin receptor blockers seem to be reasonable third–line choices, because the evidence base to support their use in patients on dialysis is sparse. Add-on therapy with mineralocorticoid receptor antagonists in specific subgroups of patients on dialysis (i.e., those with severe congestive heart failure) seems to be another promising option in anticipation of the ongoing trials evaluating their efficacy and safety. Adequately powered, multicenter, randomized trials evaluating hard cardiovascular end points are urgently warranted to elucidate the comparative effectiveness of antihypertensive drug classes in patients on dialysis. In this review, we provide an overview of the randomized evidence on pharmacotherapy of hypertension in patients on dialysis, and we conclude with suggestions for future research to address critical gaps in this important area.

Original languageEnglish (US)
Pages (from-to)2062-2075
Number of pages14
JournalClinical Journal of the American Society of Nephrology
Volume11
Issue number11
DOIs
StatePublished - 2016

Fingerprint

Antihypertensive Agents
Dialysis
Hypertension
Drug Therapy
Mineralocorticoid Receptor Antagonists
Aptitude
Angiotensin Receptor Antagonists
Calcium Channel Blockers
Enzyme Inhibitors
Multicenter Studies
Reflex
Therapeutics
Heart Failure
Pharmacokinetics
Sodium
Morbidity
Safety
Weights and Measures
Mortality
Population

Keywords

  • Adult
  • Australia
  • Biopsy
  • Child
  • deceased donor
  • focal segmental glomerulosclerosis
  • Glomerulosclerosis, Focal
  • graft survival
  • Graft Survival
  • Humans
  • Incidence
  • kidney
  • Kidney Failure, Chronic
  • kidney transplantation
  • living donor
  • Living Donors
  • Logistic Models
  • New Zealand
  • Registries
  • renal dialysis
  • risk factors

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Pharmacotherapy of hypertension in chronic dialysis patients. / Georgianos, Panagiotis I.; Agarwal, Rajiv.

In: Clinical Journal of the American Society of Nephrology, Vol. 11, No. 11, 2016, p. 2062-2075.

Research output: Contribution to journalReview article

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