ANTIHYPERTENSIVE DRUG THERAPY IN HAEMODIALYSIS PATIENTS: PP.33.319

Abstract

Blood pressure is raised in the majority of haemodialysis (HD) patients. Many of them need antihypertensive medications and some of them are resistant of antihypertensive medication. The purpose of the present cross-over observational study was to investigate the use of anti-hypertensive drugs and to compare these results with those from a preliminary study three years ago. A total of 11 dialysis centers were included in the study. Age, sex, HD duration, systolic and diastolic blood pressure before and after HD were recorded, as well as the anti-hypertensive drugs used in HD pts: beta-blockers (BB), calcium channel blockers (CCB), diuretics (D), angiotensin –converting enzyme inhibitors (ACEI), angiotensin II-receptor blockers (ARB), alpha-blockers (AB) and centrally acting drugs (CAD). Hypertension was defined as blood pressure > 140/90 mmHg before HD, or less if pts were on antihypertensive treatment. A total of 780 pts were included and hypertension was observed in 652, i.e. 83.6%. Average blood pressure before HD was 158.2 ± 24.2 systolic and 88.3 ± 15.2 mmHg. In the preliminary study three years ago the prevalence was the same, i.e. it was 84%. The most frequently used drug were CCB, in 550 pts (70%), after that BB in 335 (43%) of pts, ACEI in 312 (40%) of pts. ARB were used in only 148 (19%) of pts, diuretics in 93(19%) and CAD in 78 (10%) of pts. The majority of pts were on combined therapy, 2–4 antihypertensive drugs. ACEI and CCB were the most used combination, i.e. in more than 380 pts. Compared to the preliminary results, BB are much more frequently used today, 43% vs 20% three years ago. The management of hypertension in HD pts is still a challenge for the nephrologist. It is obvious that in a majority of the pts a multidrug regiment is necessary. In majority of pts it is not enough. Nonpharmacological measures like salt and water restriction and adequate dialysis is of tremendous importance.