A Comprehensive Review on the Efficacy of Antihypertensives in Patients With End‐Stage Renal Disease

End-stage renal disease (ESRD) patients are particularly susceptible to hypertension, as blood pressure (BP) dysregulation leads to increased mortality and morbidity, especially considering the heightened risk of cardiovascular complications, including myocardial infarction, stroke, and congestive heart failure. Given the lack of specific guidelines on therapies aimed at achieving adequate BP control in ESRD patients, we conducted a thorough literature review to identify relevant studies and articles exploring the associations of various therapies in ESRD patients and to provide a qualitative analysis based on these results. These include ACE inhibitors, ARBs, calcium channel blockers (CCBs), beta-blockers, diuretics, alpha-2 agonists, and direct vasodilators. ARBs are not affected by dialysis, while ACE inhibitors are dialyzable. Studies suggest that the incidence of cardiovascular events is significantly lower in ESRD patients receiving treatment compared to those without treatment. CCBs are nondialyzable and, thus, serve as a second-line treatment for BP control in ESRD patients. Limited evidence suggests that diuretic-based combination therapy may improve BP control in selected hemodialysis patients, but its effect on cardiovascular mortality remains uncertain. Beta-blockers have demonstrated a favorable profile but differ in dialyzability and cardioselectivity, making it challenging to endorse an ideal choice of drug. Direct vasodilators have been shown to reduce left ventricular hypertrophy, but further studies are needed to determine optimal dosing strategies. Clonidine, an alpha-2 agonist, lacks safety and efficacy evaluations but has been shown to reduce BP in ESRD patients.