title: Blood pressure recordings during hemodialysis access interventions: implications for acute management.
abstract: A retrospective study evaluating the pattern of blood pressure and its related complications before, during, and after percutaneous hemodialysis interventions was performed in patients presenting with asymptomatic hypertension. Hemodialysis patients undergoing percutaneous interventions including tunneled hemodialysis catheter insertion, percutaneous balloon angioplasty and thrombectomy procedure, and stage II hypertension (systolic blood pressure ≥160 mmHg) were included in this analysis. Blood pressure medications were not used while midazolam and fentanyl were routinely administered. Patients were followed for up to 4 weeks to monitor any complications. The mean blood pressure before, during, and after the procedures were 185 ± 18/96 ± 14, 172 ± 22/92 ± 15, and 153 ± 25/87 ± 14, respectively. There was a statistically significant difference between the blood pressure readings before and after the procedure (before = 185 ± 18/96 ± 14, after = 153 ± 25/87 ± 14; p = 0.001). None of the patients had a stroke, myocardial infarction, or acute pulmonary edema before, during, or after the procedure or during the 4-week follow-up period. A significant reduction in blood pressure was observed after the procedure without the administration of any antihypertensive medication. These results suggest that the reduction in blood pressure observed after percutaneous dialysis access interventions (particularly in the presence of midazolam and fentanyl) may make it unnecessary to treat asymptomatic hypertension prior to these procedures.
authors.affiliation: Albany Medical College and Veterans Affairs Medical Center, Albany, NY, USA. AsifA@mail.amc.edu
authors.forename: Arif
authors.initials: A
authors.lastname: Asif
authors.forename: Hector
authors.initials: H
authors.lastname: Castro
authors.forename: Ahmed Ameen
authors.initials: AA
authors.lastname: Waheed
authors.forename: Vishesh
authors.initials: V
authors.lastname: Kumar
authors.forename: Syed S
authors.initials: SS
authors.lastname: Haqqie
authors.forename: Gary
authors.initials: G
authors.lastname: Siskin
authors.forename: Roy O
authors.initials: RO
authors.lastname: Mathew
authors.forename: Darius
authors.initials: D
authors.lastname: Mason
authors.forename: Tushar
authors.initials: T
authors.lastname: Vachharajani
authors.forename: Ali
authors.initials: A
authors.lastname: Nayer
authors.forename: Donna
authors.initials: D
authors.lastname: Merrill
authors.forename: Muhammad U T
authors.initials: MU
authors.lastname: Akmal
authors.forename: Loay
authors.initials: L
authors.lastname: Salman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D015331:Cohort Studies; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D011859:Radiography; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D062666:Vascular Access Devices
chemical_list: D000959:Antihypertensive Agents