Evaluation of management and factors associated with hypertension control in hemodialysis patients at a tertiary-care hospital in Pakistan

Abstract

Hypertension is highly prevalent and poorly controlled among hemodialysis patients. However, published information regarding the management and control of hypertension among Pakistani hemodialysis patients is scarce. Our objective was to evaluate the pharmacotherapeutic management and control of hypertension and associated factors in hemodialysis patients at a tertiary-care hospital. Eligible hypertensive hemodialysis patients enrolled at the Balochistan Institute of Nephrology-Urology Quetta, Pakistan, between 1 July 2017 and 30 November 2019 were retrospectively followed for 6 months after the baseline hemodialysis session. Collected data were analyzed using SPSS version 20, and odds ratios (ORs) were calculated. Patients with mean pre-dialysis blood pressure (BP) < 140/90 and post-dialysis BP < 130/80 mmHg in the final month of study were classified as being at target BP. A total of 237 hypertensive hemodialysis patients were included in the analysis. The mean age of patients was 42.8 ± 13.2 years, and most (78.9%) had at least one comorbidity. In the final month of the study, only 68 patients (28.7%) were at target BP. Patients were treated with a median of two antihypertensive drugs (range 1–5). Calcium-channel blockers (CCBs) were the most commonly prescribed antihypertensive (54.4%), followed by angiotensin-receptor blockers (53.2%) and diuretics (42.2%). In multivariate binary logistic regression analysis, the use of diuretics (OR 0.50; 95% CI 0.27–0.95), CCBs (OR 2.90; 95% CI 1.35–6.20), β-blockers (OR 2.9; 95% CI 1.30–6.73), and α/β-blockers (OR 2.75; 95% CI 1.26–5.98) was significantly associated with hypertension control. Hypertension control was suboptimal at the study site. A notable proportion of patients were receiving diuretics despite guidelines discouraging their use. The use of β-blockers, α-β-blockers, and CCBs was associated with hypertension control.