We Hold Antihypertensives Prior To Dialysis

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Clinical Pharmacology

Background:

• Hypertension is a frequent complication in end-stage renal disease (ESRD) patients undergoing chronic hemodialysis, affecting two-thirds of this population.
• Adequate blood pressure control remains a significant challenge, with only about one-third of patients achieving target levels.
• The pathogenesis of hypertension in ESRD is complex and multifactorial, complicating treatment strategies.

Purpose of the Study:

• To discuss the challenges in managing hypertension in hemodialysis patients.
• To evaluate the implications of withholding antihypertensives before dialysis.
• To highlight the significance of intradialytic hypertension (ID-HTN) and the rationale for predialysis antihypertensive administration.

Main Methods:

• Review of current clinical practices and literature regarding hypertension management in hemodialysis.
• Analysis of the risks and benefits associated with withholding versus administering antihypertensives prior to hemodialysis.
• Discussion of the pathophysiology and clinical impact of intradialytic hypertension (ID-HTN).

Main Results:

• Common practice involves withholding antihypertensives before dialysis due to concerns about intradialytic hypotension (IDH).
• Intradialytic hypertension (ID-HTN), though less common than IDH, is associated with poor cardiovascular prognosis and reflects a higher overall hypertension burden.
• Routine withholding of antihypertensives may lead to suboptimal interdialytic blood pressure control, increased euvolemic ID-HTN, and potential hemodynamic instability during dialysis.

Conclusions:

• Withholding antihypertensives before hemodialysis is often inappropriate and can negatively impact blood pressure control and patient safety.
• Predialysis administration of antihypertensives is necessary in many cases to ensure adequate blood pressure management.
• The choice of antihypertensive medication should be individualized, considering patient comorbidities, drug pharmacokinetics, and dialyzability.