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[ACE inhibitor therapy of hemodialyzed patients]
Insights
Higher doses of angiotensin converting enzyme inhibitors (ACE inhibitors) like captopril and enalapril were used in hemodialysis patients with resistant hypertension, indicating a need for more antihypertensive agents to manage blood pressure effectively.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Context:
- Hypertension management in patients undergoing regular hemodialysis presents unique challenges.
- Angiotensin converting enzyme inhibitors (ACE inhibitors) are commonly prescribed antihypertensive agents.
- Variability in ACE inhibitor dosing across different hemodialysis units was observed.
Purpose:
- To investigate the daily dosages of captopril and enalapril in hemodialysis patients.
- To examine the relationship between ACE inhibitor doses and the number of concomitant antihypertensive medications used.
- To understand treatment patterns for hypertension in hemodialysis populations.
Summary:
- A study analyzed captopril and enalapril doses in 104 hypertensive hemodialysis patients, focusing on 23 on captopril and 17 on enalapril.
- Significant differences in average daily captopril doses were found across hemodialysis units (111, 61, 26 mg/day).
- Significant correlations were observed between captopril dose (r=0.46) and enalapril dose (r=0.50) and the number of other antihypertensive agents used, suggesting higher ACE inhibitor doses in patients with more resistant hypertension.
Impact:
- Findings suggest that higher doses of ACE inhibitors are administered to hemodialysis patients with more severe or resistant hypertension.
- This indicates a clinical strategy of escalating ACE inhibitor therapy when multiple antihypertensive agents are required.
- The study highlights the complex pharmacotherapy management in hypertensive patients on hemodialysis.
Abstract:
Authors studied the daily dose of angiotensin converting enzyme inhibitor captopril and enalapril in patients with hypertension on regular hemodialysis of three hemodialysis units, and the relationship between the daily doses of angiotensin converting enzyme inhibitors and the number of simultaneously used other antihypertensive agents in the same patients. 104 out of 133 hemodialysed patients were treated with antihypertensive agents, 53 patients received angiotensin converting enzyme inhibitor. The data of 23 captopril treated patients in 3 dialysis units and data of 17 enalapril treated patients in 2 dialysis units were used as the basis of the study. The difference between the average daily doses of captopril applied at the different hemodialysis units was significant (111, 61 and 26 mg/day). However the difference between the average doses of enalapril was not significant (18 and 12.9 mg/day). The correlation was found to be significant between the dose of captopril and the number of simultaneously used antihypertensive agents: r = 0.46, p < 0.05. The correlation was also significant between the dose of enalapril and the number of combinations of other antihypertensive agents: r = 0.50, p < 0.05. These relations and the analysis of antihypertensive therapy of 4 patients, receiving the largest doses of captopril suggest that larger doses of angiotensin converting enzyme inhibitors were used in the more resistant hypertensive patients, where more antihypertensive agents were needed to be administered to control the blood pressure.