We Hold Antihypertensives Prior To Dialysis.
Hypertension is the most common complication of end-stage renal disease and chronic hemodialysis and yet, only a third of these patients have adequately controlled blood pressures. Pathogenesis of hypertension in this population is complex and multifactorial and therefore poses numerous treatment challenges. Furthermore, it is common practice among nephrologists to withhold antihypertensives prior to a hemodialysis procedure due to concerns for intradialytic hypotension (IDH). Intradialytic hypertension (ID-HTN) is an increasingly recognized phenomenon and although less common than IDH, portends poor cardiovascular prognosis as well as reflects higher hypertension burden in the dialysis population. Withholding antihypertensives prior to dialysis routinely in patients may worsen interdialytic blood pressure control as well as increase the prevalence of euvolemic ID-HTN. It may also increase the risk of cardiac arrhythmias and further compromise hemodynamic stability during dialysis. In such situations, predialysis administration of antihypertensive is appropriate and necessary and drug choice should be based on the patient's comorbidities, pharmacokinetics of the drug and its dialyzability.
Renal Section and Medical Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.|Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut.
Namrata
N
Krishnan
Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut.
Aldo J
AJ
Peixoto
D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007022:Hypotension / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000628:therapy*; D009398:Nephrology / Q000379:methods*; D006435:Renal Dialysis
D000959:Antihypertensive Agents