SHORT-TERM BLOOD PRESSURE VARIABILITY IS REDUCED AFTER NEBIVOLOL COMPARED TO IRBESARTAN TREATMENT IN PATIENTS WITH INTRADIALYTIC HYPERTENSION

Abstract

Objective: Short-term BP variability (BPV) is associated with increased cardiovascular risk in hemodialysis. Patients with intradialytic hypertension have high risk of adverse outcomes. Studies on the effects of antihypertensive drugs on BPV in hemodialysis are scarce. This aimed to evaluate the effects of treatment with nebivolol and irbesartan on short-term BPV, using ABPM in patients with intradialytic hypertension. Design and method: This randomized-cross-over study included 38 patients (age: 60.4 ± 11.1years, male: 65.8%) with intradialytic hypertension (intradialytic-SBP rise >= 10 mmHg at > 4 over 6 consecutive sessions. After baseline evaluation, participants were randomised to nebivolol 5 mg and subsequently irbesartan 150 mg, or vice versa, with a two-week wash-out period before the initiation of the second drug. Patients had three respective 24h-ABPM starting before a midweek-session using the Mobil-O-Graph NG device (IEM, Stolberg, Germany). We calculated standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), and average real variability (ARV) of BP with validated formulas. Results: Post-hemodialysis and 24h-SBP and DBP levels were significantly lower after treatment with both drugs. Systolic-BPV indices were marginally lower after nebivolol but not after irbesartan compared to baseline (SD: baseline 15.70 ± 4.69; nebivolol 14.45 ± 3.37, p = 0.090; irbesartan 15.39 ± 3.85, p = 0.706; wSD: 14.62 ± 4.36 vs 13.40 ± 3.07, p = 0.053 vs 14.36 ± 3.47, p = 0.805 respectively). Diastolic-BPV indices decreased with nebivolol and increased with irbesartan, resulting in significant differences between the two drugs (SD: baseline 10.56 ± 2.50; nebivolol 9.75 ± 2.12; irbesartan 10.84 ± 1.98, between-drug p = 0.014; wSD: baseline 9.86 ± 2.12; nebivolol 9.34 ± 2.01; irbesartan 10.25 ± 2.01 between-drug p = 0.029). Diastolic-BPV during intradialytic and day-time periods was marginally lower with nebivolol than irbesartan. During night-time, BPV indices were unchanged with either drug. Conclusions: Short-term BPV is reduced after nebivolol but not after irbesartan treatment in patients with intradialytic hypertension. These findings suggest that increased SNS activity is one of the major factors leading to increased short-term BP fluctuations in hemodialysis patients with intradialytic hypertension.