Abstract
The aim of current study was to assess the effectiveness of losartan 50 mg in reducing blood pressure among post-dialysis euvolemic hypertensive patients, observing their survival trends and adverse events during the course of study. A multicentre, prospective, randomised, 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. Post-dialysis euvolemic assessment was done by a body composition monitor (BCM). Covariate Adaptive Randomization was used for allocation of participants to the standard or intervention arm. Of the total 229 patients, 96 (41.9%) were identified as post-dialysis euvolemic hypertensive. Final samples of 88 (40.1%) patients were randomized into standard and intervention arms. After follow-up of 12 months’ pre-dialysis systolic (p < 0.001) and diastolic (p 0.01), intradialysis diastolic (p 0.02), post-dialysis systolic (p < 0.001) and diastolic (p < 0.001) blood pressure was reduced from the baseline among intervention-arm patients Compared to only pre-dialysis systolic blood pressure (p 0.003) among standard arm patients after 12 months of follow. Total of six deaths were reported among standard-arm patients compared to 2 deaths among the intervention arm. Losartan 50 mg achieve an overall significant decline in blood pressure among post-dialysis euvolemic hypertensive patients.
Highlights
Exchangeable sodium, plasma volume and plasma-renin activity are almost twice as high in hypertensive haemodialysis patients as normotensive patients and are directly correlated with mean blood pressure[5,6]
The analysis of the current study suggests that blood volume and RAAS are two of the main factors contributing to hypertension among haemodialysis patients
Our analysis suggests this drop in post-dialyses blood pressure was significantly different from baseline and as compared to standard-arm patients that were treated with non-RAAS therapy
Summary
Exchangeable sodium, plasma volume and plasma-renin activity are almost twice as high in hypertensive haemodialysis patients as normotensive patients and are directly correlated with mean blood pressure[5,6]. A study on haemodialysis patients looking into response in RAAS with change in volume reported that patients with high plasma-renin activity before saline loading had an increase in blood pressure compared to normal or low plasma-renin activity[7]. Volume-dependent hypertensive haemodialysis patients can be managed by appropriate fluid removal This is done by identifying the correct dry weight and extracting fluid . Despite a reliable estimation of dry weight, and attaining post-dialysis euvolemic state, a group of patients are still hypertensive[11,12], because of RAAS and are known as renin-dependent hypertensive patients[9]. The aim of current study was to assess the effectiveness of Losartan (ARB) in reducing blood pressure among post-dialysis euvolemic patients and assessing their survival trends
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