Effects of Azilsartan in Ambulatory Patients on Maintenance Hemodialysis: Monitoring at Night and at Home

Background: Recently, a newly developed Angiotensin Receptor Blocker (ARB), azilsartan, has been shown to have a persistent depressor action throughout the day in hypertensive patients. However, there have been few reports discussing the efficacy of azilsartan in patients on Hemodialysis (HD). Methods: Blood Pressure (BP) measurements in the HD center, and at home and ambulatory monitoring during the night were carried out before and after the change from other ARBs to azilsartan. All patients who were persistently hypertensive despite the treatment with antihypertensive drugs including ARB were considered as candidates. All patients were on antihypertensive treatment (12 on calcium channel blockers (CCBs), 6 on alpha blockers, and 2 on beta blockers and 4 on centrally acting antihypertensive drugs). Initially, azilsartan was started at 20 mg once daily in the evening, and increased up to 40 mg once daily in the evening. Results: Pre-dialytic systolic BP (SBP), SBP in the morning at home and during night were all significantly reduced by 3 months’ administration of azilsartan: (167.3 ± 10.3 to 145.3 ± 9.6 (pre-dialytic); 167.1 ± 11.0 to 151.8 ± 10.4 (at home); 150.5 ± 13.1 to 134.0 ± 10.3 (during night); mmHg). Conclusion: The present study demonstrated that azilsartan reduced SBP of pre-and post HD session measured at a dialysis center, on the morning of HD days and at the night time after HD. In addition to reduction of SBPs, azilsartan stabilized BP during the night. Furthermore, azilsartan significantly attenuated reduction of SBP from the start to the end of HD session.