Key result
Taking ≥4 antihypertensive medications in ESRD patients was associated with higher mean systolic blood pressure compared to 0-1 medications (165 vs 139 mm Hg; P=0.01).
Why the study?
Does escalating the number of antihypertensive medications improve blood pressure control in end-stage renal disease patients?
Cross-Sectional (n=106)
Does escalating the number of antihypertensive medications improve blood pressure control in end-stage renal disease patients?
In ESRD patients on hemodialysis, taking a higher number of antihypertensive medications is paradoxically associated with worse blood pressure control, suggesting that simply escalating medical therapy may be ineffective for resistant hypertension in this population.
Higher BP despite ≥4 meds warrants caution against assuming escalation suffices in ESRD; leaves open whether intensification improves control.
The authors examined the efficacy of antihypertensive medication use in end-stage renal disease (ESRD). They compared achieved blood pressures (BPs) in a cross-sectional study of 106 ESRD patients whose medications had not been changed for at least 2 months. Group 1 (n=36) included patients who took 0 or 1 medication; group 2 (n=56), 2 or 3 medications; and group 3 (n=14), > or =4 medications. The population's mean age was 55.1 years, 87% were African American, and 57% were men weighing 76.9 kg who were on 229 minutes of hemodialysis with an edKt/V of 1.35; there was no difference between the 3 groups. The authors found a difference in the mean BPs: 139/72 mm Hg in group 1, 154/82 mm Hg in group 2, and 165/91 mm Hg in group 3 (P=.01 for systolic, P=.002 for diastolic), with a mean arterial pressure difference of 94.4, 106.4, and 115.4 mm Hg (P=.002). The authors conclude that in this group of primarily African American patients, the control of hypertension in ESRD is not achieved by escalating the number of antihypertensive medications.
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Tapolyai et al. (2008) conducted a cross-sectional in End-stage renal disease (ESRD) (n=106). ≥4 antihypertensive medications vs. 0 or 1 antihypertensive medication was evaluated on Mean systolic blood pressure (p=.01). Taking ≥4 antihypertensive medications in ESRD patients was associated with higher mean systolic blood pressure compared to 0-1 medications (165 vs 139 mm Hg; P=0.01).
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