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Short and Long-Term Effects of the Angiotensin II Receptor Blocker Irbesartan on Intradialytic Central Hemodynamics:
Christian Daugaard Peters1, Krista Dybtved Kjaergaard1, Jens Dam Jensen1
1Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Insights
Angiotensin II receptor blockers (ARBs) like irbesartan did not alter hemodynamics during hemodialysis. This study found no significant increase in hypotensive episodes when ARBs were added to antihypertensive therapy.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Pharmacology
Background:
- Tolerability of antihypertensive drugs during hemodialysis is not well understood.
- Angiotensin II receptor blockers (ARBs) are a class of antihypertensive medications.
- This study investigated the safety and efficacy of irbesartan in hemodialysis patients.
Purpose of the Study:
- To evaluate the tolerability and hemodynamic effects of irbesartan in patients undergoing hemodialysis.
- To determine if adding irbesartan to existing antihypertensive treatment impacts intradialytic hemodynamics.
- To assess the frequency of intradialytic hypotension with irbesartan use.
Main Methods:
- A randomized, double-blind, placebo-controlled trial was conducted over one year.
- Eighty-two hemodialysis patients with urine output >300 mL/day and dialysis vintage <1 year were included.
- Patients received either irbesartan (300 mg/day) or placebo as add-on therapy, targeting a predialytic systolic blood pressure of 140 mmHg.
Main Results:
- Both irbesartan and placebo groups showed similar reductions in predialytic systolic blood pressure over the year.
- Hemodynamic parameters such as cardiac output, stroke volume, and mean arterial pressure remained stable and comparable between groups.
- No significant difference in the number of intradialytic hypotensive episodes was observed between the irbesartan and placebo groups (50 vs. 63, P=0.4).
Conclusions:
- Irbesartan, as an add-on antihypertensive therapy, did not significantly affect intradialytic hemodynamics in the short or long term.
- The addition of irbesartan did not lead to a significant increase in hypotensive episodes during hemodialysis.
- The findings suggest that irbesartan is a tolerable option for managing hypertension in select hemodialysis patients.
Background And Aim:
Little is known about the tolerability of antihypertensive drugs during hemodialysis treatment. The present study evaluated the use of the angiotensin II receptor blocker (ARB) irbesartan.
Design:
Randomized, double-blind, placebo-controlled, one-year intervention trial.
Setting And Participants:
Eighty-two hemodialysis patients with urine output >300 mL/day and dialysis vintage <1 year.
Intervention:
Irbesartan/placebo 300 mg/day for 12 months administered as add-on to antihypertensive treatment using a predialytic systolic blood pressure target of 140 mmHg in all patients.
Outcomes And Measurements:
Cardiac output, stroke volume, central blood volume, total peripheral resistance, mean arterial blood pressure, and frequency of intradialytic hypotension.
Results:
At baseline, the groups were similar regarding age, comorbidity, blood pressure, antihypertensive medication, ultrafiltration volume, and dialysis parameters. Over the one-year period, predialytic systolic blood pressure decreased significantly, but similarly in both groups. Mean start and mean end cardiac output, stroke volume, total peripheral resistance, heart rate, and mean arterial pressure were stable and similar in the two groups, whereas central blood volume increased slightly but similarly over time. The mean hemodynamic response observed during a dialysis session was a drop in cardiac output, in stroke volume, in mean arterial pressure, and in central blood volume, whereas heart rate increased. Total peripheral resistance did not change significantly. Overall, this pattern remained stable over time in both groups and was uninfluenced by ARB treatment. The total number of intradialytic hypotensive episodes was (placebo/ARB) 50/63 (P = 0.4). Ultrafiltration volume, left ventricular mass index, plasma albumin, and change in intradialytic total peripheral resistance were significantly associated with intradialytic hypotension in a multivariate logistic regression analysis based on baseline parameters.
Conclusion:
Use of the ARB irbesartan as an add-on to other antihypertensive therapy did not significantly affect intradialytic hemodynamics, neither in short nor long-term, and no significant increase in hypotensive episodes was seen.
Trial Registration:
Clinicaltrials.gov NCT00791830.
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