Antihypertensive Agents in the Dialysis Patient

Michelle A Fravel; Elizabeth Bald; Mony Fraer

doi:10.1007/s11906-019-0909-z

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Antihypertensive Agents in the Dialysis Patient

Journal article

Peer reviewed

Antihypertensive Agents in the Dialysis Patient

Michelle A Fravel, Elizabeth Bald and Mony Fraer

Current hypertension reports, Vol.21(1), pp.5-11

01/18/2019

DOI: 10.1007/s11906-019-0909-z

PMID: 30659374

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Abstract

Hypertension and antihypertensive drug utilization are remarkably prevalent in ESRD patients. Management of blood pressure elevation in this population is complicated by many factors, including a multidimensional etiology, challenges in obtaining accurate and appropriately timed blood pressure measurements, highly specific drug dosing requirements, and a paucity of outcomes-based evidence to guide management decisions. The purpose of this review is to summarize and apply knowledge from existing clinical trials to enhance safe and effective use of antihypertensive agents in dialysis patients. Two meta-analyses have established the benefit of antihypertensive therapy in ESRD. Data supporting the use of one antihypertensive class over another is less robust; however, beta-blockers have more clearly demonstrated improved cardiovascular outcomes in prospective randomized trials. Interdialytic home blood pressure monitoring has been demonstrated to be better associated with cardiovascular outcomes than clinic pre- or post-dialysis readings and should ideally be considered as a routine part of blood pressure management in this population. As data from small trials provides limited guidance for the management of hypertension in ESRD, more research is needed to guide medication selection and utilization. Specifically, large prospective randomized trails comparing cardiovascular outcomes of various medication classes and differing blood pressure targets are needed.

Mineralocorticoid Receptor Antagonists - administration & dosage

Angiotensin Receptor Antagonists - pharmacokinetics

Vasodilator Agents - pharmacokinetics

Humans

Antihypertensive Agents - administration & dosage

Hypertension - drug therapy

Angiotensin-Converting Enzyme Inhibitors - pharmacokinetics

Antihypertensive Agents - pharmacokinetics

Angiotensin-Converting Enzyme Inhibitors - administration & dosage

Adrenergic alpha-2 Receptor Antagonists - pharmacokinetics

Dose-Response Relationship, Drug

Kidney Failure, Chronic - therapy

Adrenergic beta-Antagonists - pharmacokinetics

Calcium Channel Blockers - administration & dosage

Kidney Failure, Chronic - complications

Hypertension - complications

Adrenergic alpha-2 Receptor Antagonists - administration & dosage

Calcium Channel Blockers - pharmacokinetics

Mineralocorticoid Receptor Antagonists - pharmacokinetics

Vasodilator Agents - administration & dosage

Adrenergic beta-Antagonists - administration & dosage

Blood Pressure Determination

Angiotensin Receptor Antagonists - administration & dosage

Renal Dialysis

Details

Title: Subtitle: Antihypertensive Agents in the Dialysis Patient
Creators: Michelle A Fravel - Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, 220 PHAR, 115 S. Grand Ave., Iowa City, IA, 52242, USA. michelle-fravel@uiowa.edu
Elizabeth Bald - Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Mony Fraer - Division of Nephrology and Hypertension, Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
Resource Type: Journal article
Publication Details: Current hypertension reports, Vol.21(1), pp.5-11
DOI: 10.1007/s11906-019-0909-z
PMID: 30659374
ISSN: 1522-6417
eISSN: 1534-3111
Language: English
Date published: 01/18/2019
Academic Unit: Pharmacy Practice and Science; Nephrology; Internal Medicine
Record Identifier: 9984094540702771

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