Antihypertensive Agents in the Dialysis Patient

Autor: Elizabeth Bald, Michelle A. Fravel, Mony Fraer
Rok vydání: 2019
Předmět:
Nephrology
medicine.medical_specialty
medicine.drug_class
medicine.medical_treatment
Vasodilator Agents
Population
Adrenergic beta-Antagonists
Angiotensin-Converting Enzyme Inhibitors
030204 cardiovascular system & hematology
law.invention
03 medical and health sciences
Angiotensin Receptor Antagonists
0302 clinical medicine
Randomized controlled trial
law
Renal Dialysis
Internal medicine
Internal Medicine
medicine
Humans
030212 general & internal medicine
education
Intensive care medicine
Antihypertensive drug
Dialysis
Antihypertensive Agents
Mineralocorticoid Receptor Antagonists
education.field_of_study
Dose-Response Relationship
Drug
business.industry
Blood Pressure Determination
Adrenergic alpha-2 Receptor Antagonists
Calcium Channel Blockers
Clinical trial
Blood pressure
Hypertension
Kidney Failure
Chronic
Hemodialysis
business
Zdroj: Current hypertension reports. 21(1)
ISSN: 1534-3111
Popis: 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.
Databáze: OpenAIRE
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