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. 2024 Oct 1;19(10):1310-1318.
doi: 10.2215/CJN.0000000000000521. Epub 2024 Jul 16.

Antihypertensive Drug Treatment and the Risk for Intrahemodialysis Hypotension

Carmine Zoccali  1   2   3 , Giovanni Tripepi  4 , Paola Carioni  5 , Edouard L Fu  6 , Friedo Dekker  7 , Vianda Stel  8   9 , Kitty J Jager  8   9 , Francesca Mallamaci  4   10 , Jeffrey L Hymes  11 , Franklin W Maddux  11 , Stefano Stuard  12
Affiliations

Antihypertensive Drug Treatment and the Risk for Intrahemodialysis Hypotension

Carmine Zoccali et al. Clin J Am Soc Nephrol. .

Abstract

Key Points:

  1. Antihypertensive medications are often used by hemodialysis patients, and intradialytic hypotension is a common complication in these patients.

  2. The study emulates a randomized clinical trial comparing antihypertensive drug treatment for the risk of hemodialysis hypotension in 4072 incident patients.

  3. Compared with calcium antagonists, β and α–β blockers, angiotensin converting enzyme inhibitors or angiotensin II antagonists, and diuretics may increase the risk of hemodialysis hypotension.

Background: Antihypertensive medications are often prescribed to manage hypertension in hemodialysis patients, and intradialytic hypotension (IDH) is a common complication in these patients. We investigated the risk of IDH in incident hemodialysis patients who initiated treatment with antihypertensive drugs in monotherapy.

Methods: The study was conducted as an emulation of a randomized clinical trial in 4072 incident hemodialysis patients who started antihypertensive drug treatment between January 2016 and December 2019. The primary outcome was the occurrence of IDH during hemodialysis sessions. The generalized estimating equation analysis was adjusted by inverse probability treatment weighting.

Results: Calcium channel blocker (CCB) use was associated with an IDH incidence rate of 7.4 events per person-year (95% confidence interval [CI], 6.2 to 8.6). Compared with CCB use, use of β and α–β blockers was strongly associated with a higher likelihood of IDH (odds ratio [OR] [95% CI, 2.27; 1.50 to 3.43]). The use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (OR [95% CI, 1.71; 1.14 to 2.57]) and diuretics (OR [95% CI, 1.52; 1.07 to 2.16]) were also associated with a higher likelihood of IDH compared with CCB use.

Conclusions: The study suggests that using β and α–β blockers, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and diuretics may increase the risk of IDH in hemodialysis patients compared with CCB use.

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Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/CJN/B967.

Figures

None
Graphical abstract
Figure 1
Figure 1
Flow of patients across the study. ACE, angiotensin converting enzyme.
Figure 2
Figure 2
Incidence rate of IDH according to each antihypertensive drugsclass. Data are events per person-year and 95% CI. Light gray columns represent the incidence rate of IDH in the combined group of patients on α–β blockers or β blockers and of those on ACE inhibitors or ARBs. ARB, angiotensin II receptor blocker; CI, confidence interval; IDH, intradialytic hypotension.
Figure 3
Figure 3
ORs, 95% CIs, and P values for IDH of antihypertensive drugs class versus the common comparator (CCBs). The effect of each drug is derived from the IPTW GEE model given in Table 3—model 2. CCB, calcium channel blocker; GEE, generalized estimating equation; IPTW, inverse probability treatment weighting; OR, odds ratio.
See this image and copyright information in PMC

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