Supervised atenolol therapy in the management of hemodialysis hypertension

Research output: Contribution to journalArticle

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Abstract

Background. Uncontrolled hypertension continues to be a common problem, particularly in noncompliant hemodialysis patients. Atenolol, a water soluble β-blocker has a prolonged half-life in renal failure and may serve as a useful antihypertensive agent in these patients. Methods. Hypertension was diagnosed by ambulatory blood pressure monitoring for 44 hours during an interdialytic interval in eight chronic hemodialysis patients receiving no antihypertensive therapy. An average daytime blood pressure greater than 140/90 mm Hg or an average nighttime blood pressure greater than 120/80 mm Hg was used to define uncontrolled hypertension. Patients were then administered atenolol (25 mg) following hemodialysis three times a week. The efficacy of therapy was judged by ambulatory blood pressure monitoring three weeks after instituting atenolol therapy. Blood pressure loads above the threshold blood pressures during the day or night were also calculated and compared before and after three weeks of atenolol therapy. Results. The mean 44-hour ambulatory blood pressure (ABP) fell from 144 ± 14/80 ± 7 mm Hg to 127 ± 13/69 ± 10 mm Hg (P < 0.001). The heart rate fell from 85 ± 11 to 70 ± 11 beats per minute. The systolic and diastolic blood pressure load was reduced from 71 ± 25% and 30 ± 24% to 35 ± 26% and 11 ± 17%, respectively (P < 0.001). There was a persistent antihypertensive effect over 44 hours. The blood pressure reduction was achieved without any increase in intradialytic symptomatic or asymptomatic hypotensive episodes, reduction in delivered dialysis, or statistically significant changes in serum potassium or glucose. Conclusions. A supervised administration of atenolol following hemodialysis effectively and safely controls hypertension in chronic hemodialysis patients. This therapy can be particularly valuable for noncompliant hemodialysis patients.

Original languageEnglish
Pages (from-to)1528-1535
Number of pages8
JournalKidney International
Volume55
Issue number4
DOIs
StatePublished - 1999

Fingerprint

Atenolol
Renal Dialysis
Blood Pressure
Hypertension
Antihypertensive Agents
Ambulatory Blood Pressure Monitoring
Therapeutics
Renal Insufficiency
Half-Life
Dialysis
Potassium
Heart Rate
Glucose
Water
Serum

Keywords

  • Antihypertensive agents
  • Atenolol
  • Beta blocker
  • Blood pressure
  • Renal failure

ASJC Scopus subject areas

  • Nephrology

Cite this

Supervised atenolol therapy in the management of hemodialysis hypertension. / Agarwal, Rajiv.

In: Kidney International, Vol. 55, No. 4, 1999, p. 1528-1535.

Research output: Contribution to journalArticle

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AB - Background. Uncontrolled hypertension continues to be a common problem, particularly in noncompliant hemodialysis patients. Atenolol, a water soluble β-blocker has a prolonged half-life in renal failure and may serve as a useful antihypertensive agent in these patients. Methods. Hypertension was diagnosed by ambulatory blood pressure monitoring for 44 hours during an interdialytic interval in eight chronic hemodialysis patients receiving no antihypertensive therapy. An average daytime blood pressure greater than 140/90 mm Hg or an average nighttime blood pressure greater than 120/80 mm Hg was used to define uncontrolled hypertension. Patients were then administered atenolol (25 mg) following hemodialysis three times a week. The efficacy of therapy was judged by ambulatory blood pressure monitoring three weeks after instituting atenolol therapy. Blood pressure loads above the threshold blood pressures during the day or night were also calculated and compared before and after three weeks of atenolol therapy. Results. The mean 44-hour ambulatory blood pressure (ABP) fell from 144 ± 14/80 ± 7 mm Hg to 127 ± 13/69 ± 10 mm Hg (P < 0.001). The heart rate fell from 85 ± 11 to 70 ± 11 beats per minute. The systolic and diastolic blood pressure load was reduced from 71 ± 25% and 30 ± 24% to 35 ± 26% and 11 ± 17%, respectively (P < 0.001). There was a persistent antihypertensive effect over 44 hours. The blood pressure reduction was achieved without any increase in intradialytic symptomatic or asymptomatic hypotensive episodes, reduction in delivered dialysis, or statistically significant changes in serum potassium or glucose. Conclusions. A supervised administration of atenolol following hemodialysis effectively and safely controls hypertension in chronic hemodialysis patients. This therapy can be particularly valuable for noncompliant hemodialysis patients.

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