The Impact of Antihypertensive Medications on Intradialytic Hypotension

The Global Medical Office (GMO) is pleased to share the publication of important research about intradialytic hypotension (IDH) and antihypertensive medication in the Clinical Journal of the American Society of Nephrology (CJASN).

Under the leadership of Dr. Carmine Zoccali, a team of distinguished researchers collaborated across diverse institutions and geographies to investigate whether antihypertensive medications are associated with an increased risk of IDH.

What is Intradialytic Hypotension?

IDH is a common complication for hemodialysis (HD) patients that may lead to serious adverse outcomes, such as cardiovascular events and mortality. While HD patients are often prescribed antihypertensive medications to manage hypertension, the impact of these medications on the risk of IDH is not well understood.

To better understand the risk of IDH in these patients, the research team emulated a randomized clinical trial (RCT) comparing antihypertensive drug treatment for the risk of hypotension in 4,072 incident patients on HD. The trial randomized patients to four classes of antihypertensive drugs commonly used in HD patients: calcium channel blockers, beta blockers and alpha-beta blockers, angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), and diuretics.

The selected patient population included adult patients (over 18 years old) who initiated HD treatment with antihypertensive drugs in monotherapy in NephroCare dialysis centers in Turkey, Russia, Spain, Portugal, Italy, Slovakia, and the Czech Republic between January 2016 and December 2019.

Study Design and Results

The design of this study had several advantages and has the potential to inform the design of future RCTs. The approach included the ability to examine the impact of antihypertensive medications on IDH in a large and diverse patient population, as well as the prevention of immortal time bias, lead time bias, and selection bias, which are the main methodological threats when comparing the effect of medications in observational settings.

The results of the study provide great insights into preventing IDH in people with end stage kidney disease (ESKD) and suggests that use of beta and alpha-beta blockers, ACE inhibitors or ARBs, and diuretics, was strongly associated with a higher likelihood of IDH compared to calcium channel blocker use. Furthermore, the study showed that hemodiafiltration (HDF) may lessen the risk for IDH.

To read the full manuscript in CJASN, click here.

Publication date: August 2024