Abstract
ObjectivesExisting literature does not provide enough information on evaluation of factors associated with pre-dialysis controlled hypertension among euvolemic hemodialysis (HD) patients. We conducted a study to evaluate the rate and factors influencing pre-dialysis controlled hypertension among euvolemic HD patients.DesignA multicenter prospective follow-up study.SettingTertiary care teaching hospital and its associated private dialysis centers.ParticipantsThis study included 145 euvolemic eligible hypertensive patients. Various sociodemographic, clinical factors and drugs were investigated and analyzed by using appropriate statistical methods to determine the factors influencing hypertension control among the study participants.ResultsOn baseline visit, the mean pre-dialysis systolic and diastolic BP (mmHg) of study participants was 161.2 ± 24. and 79.21 ± 11.8 retrospectively, and 30 (20.6%) patients were on pre-dialysis goal BP. At the end of the 6-months follow-up, the mean pre-dialysis systolic BP and diastolic BP (mmHg) of the patients was 154.6 ± 18.3 and 79.2 ± 11.8 respectively, and 42 (28.9%) were on pre-dialysis goal BP. In multivariate analysis, the use of calcium channel blockers (CCBs) was the only variable which had statistically significant association with pre-dialysis controlled hypertension at baseline (OR = 7.530, p-value = 0.001) and final (OR = 8.988, p-value < 0.001) visits.ConclusionsIn present study, the positive association observed between CCBs and controlled hypertension suggests that CCBs are effective antihypertensive drugs in the management of hypertension among euvolemic HD patients.Strengths and limitations of this studyThis study involved a group of patients from tertiary-level teaching hospital and its associated private dialysis centers of Malaysia.To the best of the authors’ knowledge, this is the first study to assess the factors influencing pre-dialysis controlled hypertension in a cohort of 145 euvolemic HD patients in a Malaysian setting.For determining the factors influencing hypertenion control multivariate analysis was conducted.Being a prospective follow-up study, the findings of the present study need to be interpreted with caution since it is limited to only 6 months follow up.Nevertheless, a multicenter study with a large sample size and longer follow up time is needed to confirm the findings of the current study.
Highlights
Hypertension is common and often poorly controlled among hemodialysis (HD) patients
In present study, the positive association observed between Calcium channel blockers (CCB) and controlled hypertension suggests that CCBs are effective antihypertensive drugs in the management of hypertension among euvolemic HD patients
Discussion the use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are associated with reduction of blood pressure (BP) in HD patients [8] limited literature is available on the evaluation of factors associated with pre-dialysis controlled hypertension among euvolemic hemodialysis patients
Summary
Volume overload is considered as an important cause of hypertension where patients may remain hypertensive even after thrice weekly HD sessions. In such patients, non-volume mechanisms such as activation of the renin angiotensin system and/or sympatho-adrenal activities, are important contributors to hypertension [1,2,3]. Blood pressure (BP) control and cardiovascular outcomes can be improved by combining ACE inhibitors and angiotensin receptor blockers (ARBs) therapies [9]. There is limited literature available on the role of CCBs regarding the management of hypertension among HD patients
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