Abstract
To assess the effectiveness of losartan 50 mg on post dialysis euvolemic hypertensive patients against standard antihypertensive pharmacotherapy. A multicentre, prospective, randomized, single-blind trial was conducted to assess the effect of losartan 50 mg every other day (EOD), once a morning (OM) among post-dialysis euvolemic hypertensive patients. Covariate-adaptive randomization was used to allocate participants to a standard or treatment arm, and they were followed up for eight weeks. Pre-, intra- and post-dialysis session blood pressure (BP) measurements were recorded along with any adverse events. A total of 88 patients were randomized into standard (n = 44) and treatment arms (n = 44) and were followed for a period of 8 weeks. In the standard group, the mean post-dialysis blood pressure dropped by 0.3 mmHg by the end of the 8th week. However the treatment arm reported a drop of 2.4 mmHg of BP drop during the 8-week trial period. Analysis suggests that there was a significant difference in blood pressure readings at the end of 8 weeks among patients treated with losartan (P < 0.001). However, no such statistical association was observed in the standard arm (P 0.75). A slow, steady significant decline in post-dialysis BP was observed among euvolemic hypertensive patients that were treated with losartan 50 mg.
Highlights
Hypertension in haemodialysis is multi-factorial and is not completely elucidated with volume overload
The mean age & median age age of both the arms were similar. 31 (70.5%) diabetic patients were randomized to the standard arm whereas 28 (63.6%) diabetic patients were randomized to the treatment arm (Table 1)
The current study reports a drop in pre-dialysis blood pressure by 3.2/1 mmHg in the standard arm and 9/2.5 mmHg in the treatment arm during the 8-week study period
Summary
Hypertension in haemodialysis is multi-factorial and is not completely elucidated with volume overload. The renin angiotensin system is activated in haemodialysis patients by the fact that renin is increased with haemodialysis ultra-filtration leading to hypertension[3]. Similar clinical data suggests kidney disease progression is related to aldosterone, as literature suggest elevated aldosterone levels were observed in patients with average creatinine clearance of
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