Abstract
Background: Recently, a newly developed Angiotensin Receptor Blocker (ARB), azilsartan, has been shown to have a persistent depressor action throughout the day in hypertensive patients. However, there have been few reports discussing the efficacy of azilsartan in patients on Hemodialysis (HD). Methods: Blood Pressure (BP) measurements in the HD center, and at home and ambulatory monitoring during the night were carried out before and after the change from other ARBs to azilsartan. All patients who were persistently hypertensive despite the treatment with antihypertensive drugs including ARB were considered as candidates. All patients were on antihypertensive treatment (12 on calcium channel blockers (CCBs), 6 on alpha blockers, and 2 on beta blockers and 4 on centrally acting antihypertensive drugs). Initially, azilsartan was started at 20 mg once daily in the evening, and increased up to 40 mg once daily in the evening. Results: Pre-dialytic systolic BP (SBP), SBP in the morning at home and during night were all significantly reduced by 3 months’ administration of azilsartan: (167.3 ± 10.3 to 145.3 ± 9.6 (pre-dialytic); 167.1 ± 11.0 to 151.8 ± 10.4 (at home); 150.5 ± 13.1 to 134.0 ± 10.3 (during night); mmHg). Conclusion: The present study demonstrated that azilsartan reduced SBP of pre-and post HD session measured at a dialysis center, on the morning of HD days and at the night time after HD. In addition to reduction of SBPs, azilsartan stabilized BP during the night. Furthermore, azilsartan significantly attenuated reduction of SBP from the start to the end of HD session.
Highlights
Hypertension is prevalent and closely associated with cardiovascular disease (CVD) in patients receiving hemodialysis (HD) therapy [1].A recent meta-analysis and two observational studies including the Japanese Renal Data Registry [2] and US renal Data System [3] have demonstrated better outcomes in patients treated with antihypertensive agents than those without antihypertensive agents in HD patients [4].Among the antihypertensive agents, the inhibitory role of the reninangiotensin system (RAS) remains questionable [5,6,7]
Central systolic pressure was significantly lower than peripheral systolic blood pressures (BPs) (SBP) during the night after HD measured by BPro
This pressure was significantly reduced after azilsartan administration
Summary
Hypertension is prevalent and closely associated with cardiovascular disease (CVD) in patients receiving hemodialysis (HD) therapy [1].A recent meta-analysis and two observational studies including the Japanese Renal Data Registry [2] and US renal Data System [3] have demonstrated better outcomes in patients treated with antihypertensive agents than those without antihypertensive agents in HD patients [4].Among the antihypertensive agents, the inhibitory role of the reninangiotensin system (RAS) remains questionable [5,6,7]. An in vitro study has shown that azilsartan, a newly developed angiotensin receptor antagonist (ARB), has a higher affinity for and a slower dissociation from the angiotensin type 1 receptor than other ARBs [8]. Recent clinical studies [9,10] have clearly demonstrated that once–daily azilsartan administration persistently lowers 24-hour blood pressures (BPs) and improves nocturnal hypertension more effectively than other ARBs. To examine the effects of azilsartan on BP in HD patients, BP of HD patients was measured by taking interdialytic ambulatory BP measurements during the night and self-measurements of BP at home in addition to regular BP measurements in the HD center. A newly developed Angiotensin Receptor Blocker (ARB), azilsartan, has been shown to have a persistent depressor action throughout the day in hypertensive patients. There have been few reports discussing the efficacy of azilsartan in patients on Hemodialysis (HD)
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