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Intensive Hemodialysis, Blood Pressure, and Antihypertensive Medication Use.
Am J Kidney Dis. 2016 Nov; 68(5S1):S15-S23.AJ

Abstract

Hypertension is a cardinal feature of end-stage renal disease (ESRD). Hypertensive nephropathy is the primary cause of ESRD for nearly 30% of patients, and the prevalence of hypertension is >85% in new patients with ESRD. In contemporary hemodialysis (HD) patients, mean predialysis systolic blood pressure (SBP) is nearly 150mmHg, and about 70%, 50%, and 40% use β-blockers, calcium channel blockers, and renin-angiotensin system inhibitors, respectively. Predialysis SBP generally exhibits a U-shaped association with mortality risk. Interdialytic ambulatory SBP is more strongly associated with risk. Hypertension is multifactorial; key causes include persistent hypervolemia and elevated peripheral resistance. With 3 HD sessions per week, blood pressure (BP) climbs during the interdialytic interval, in step with interdialytic weight gain, particularly among elderly patients and those with higher dry weight. Elevated peripheral resistance can be attributed to inappropriate activation of the sympathetic nervous system due to higher plasma norepinephrine concentrations. Multiple randomized clinical trials show that intensive HD reduces BP and the need for oral medications indicated for hypertension. In the first 2 months of the Frequent Hemodialysis Network trial, the short daily schedule reduced predialysis SBP by 7.7mmHg, whereas the nocturnal schedule reduced predialysis SBP by 7.3mmHg, both relative to 3 sessions per week. Improvements were sustained after 12 months. Both schedules reduced antihypertensive medication use relative to 3 sessions per week. In FREEDOM (Following Rehabilitation, Economics, and Everyday-Dialysis Outcome Measurements), a prospective cohort study of short daily HD, the mean number of prescribed antihypertensive agents decreased from 1.7 to 1.0 in 1 year, whereas the percentage of patients not prescribed antihypertensive agents increased from 21% to 47%. Nocturnal HD appears to markedly reduce total peripheral resistance and plasma norepinephrine and restore endothelium-dependent vasodilation. In conclusion, intensive HD reduces BP and the need for antihypertensive medications.

Authors+Show Affiliations

American Society of Hypertension Comprehensive Hypertension Center, Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Chicago Medicine, Chicago, IL.Wake Forest University Medical Center, Winston-Salem, NC.Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN. Electronic address: wein0205@umn.edu.Baylor University Medical Center, Dallas, TX; Baylor Heart and Vascular Institute, Dallas, TX; Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX; The Heart Hospital Baylor Plano, Plano, TX.Indiana University Medical School, Indianapolis, IN.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27772639

Citation

Bakris, George L., et al. "Intensive Hemodialysis, Blood Pressure, and Antihypertensive Medication Use." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 68, no. 5S1, 2016, pp. S15-S23.
Bakris GL, Burkart JM, Weinhandl ED, et al. Intensive Hemodialysis, Blood Pressure, and Antihypertensive Medication Use. Am J Kidney Dis. 2016;68(5S1):S15-S23.
Bakris, G. L., Burkart, J. M., Weinhandl, E. D., McCullough, P. A., & Kraus, M. A. (2016). Intensive Hemodialysis, Blood Pressure, and Antihypertensive Medication Use. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 68(5S1), S15-S23. https://doi.org/10.1053/j.ajkd.2016.05.026
Bakris GL, et al. Intensive Hemodialysis, Blood Pressure, and Antihypertensive Medication Use. Am J Kidney Dis. 2016;68(5S1):S15-S23. PubMed PMID: 27772639.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intensive Hemodialysis, Blood Pressure, and Antihypertensive Medication Use. AU - Bakris,George L, AU - Burkart,John M, AU - Weinhandl,Eric D, AU - McCullough,Peter A, AU - Kraus,Michael A, PY - 2016/02/16/received PY - 2016/05/25/accepted PY - 2016/10/25/pubmed PY - 2017/6/2/medline PY - 2016/10/25/entrez KW - Antihypertensive medication KW - Frequent Hemodialysis Network KW - blood pressure KW - cardiovascular disease KW - chronic kidney disease KW - daily dialysis KW - end-stage renal disease (ESRD) KW - fluid overload KW - home dialysis KW - hypertension KW - intensive hemodialysis KW - nocturnal hemodialysis KW - review KW - short daily hemodialysis KW - ultrafiltration SP - S15 EP - S23 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 68 IS - 5S1 N2 - Hypertension is a cardinal feature of end-stage renal disease (ESRD). Hypertensive nephropathy is the primary cause of ESRD for nearly 30% of patients, and the prevalence of hypertension is >85% in new patients with ESRD. In contemporary hemodialysis (HD) patients, mean predialysis systolic blood pressure (SBP) is nearly 150mmHg, and about 70%, 50%, and 40% use β-blockers, calcium channel blockers, and renin-angiotensin system inhibitors, respectively. Predialysis SBP generally exhibits a U-shaped association with mortality risk. Interdialytic ambulatory SBP is more strongly associated with risk. Hypertension is multifactorial; key causes include persistent hypervolemia and elevated peripheral resistance. With 3 HD sessions per week, blood pressure (BP) climbs during the interdialytic interval, in step with interdialytic weight gain, particularly among elderly patients and those with higher dry weight. Elevated peripheral resistance can be attributed to inappropriate activation of the sympathetic nervous system due to higher plasma norepinephrine concentrations. Multiple randomized clinical trials show that intensive HD reduces BP and the need for oral medications indicated for hypertension. In the first 2 months of the Frequent Hemodialysis Network trial, the short daily schedule reduced predialysis SBP by 7.7mmHg, whereas the nocturnal schedule reduced predialysis SBP by 7.3mmHg, both relative to 3 sessions per week. Improvements were sustained after 12 months. Both schedules reduced antihypertensive medication use relative to 3 sessions per week. In FREEDOM (Following Rehabilitation, Economics, and Everyday-Dialysis Outcome Measurements), a prospective cohort study of short daily HD, the mean number of prescribed antihypertensive agents decreased from 1.7 to 1.0 in 1 year, whereas the percentage of patients not prescribed antihypertensive agents increased from 21% to 47%. Nocturnal HD appears to markedly reduce total peripheral resistance and plasma norepinephrine and restore endothelium-dependent vasodilation. In conclusion, intensive HD reduces BP and the need for antihypertensive medications. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/27772639/Intensive_Hemodialysis_Blood_Pressure_and_Antihypertensive_Medication_Use_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(16)30264-5 DB - PRIME DP - Unbound Medicine ER -