From the FDA Drug Label
When given together with thiazide-type diuretics, the blood pressure lowering effects of the two drugs are approximately additive. Impaired renal function decreases elimination of lisinopril, which is excreted principally through the kidneys, but this decrease becomes clinically important only when the glomerular filtration rate is below 30 mL/min. Lisinopril can be removed by hemodialysis.
- Lisinopril is a medication that can be used to manage hypertension in patients with End-Stage Renal Disease (ESRD) on Hemodialysis (HD) 1.
- Losartan may also be considered for the management of hypertension, but there is limited information in the provided drug label about its use specifically in patients with ESRD on HD 2.
- However, ACE inhibitors like lisinopril should be used with caution in patients with renal impairment, and the dose may need to be adjusted based on the glomerular filtration rate.
- It is essential to monitor the patient's renal function and adjust the medication regimen accordingly.
From the Research
For patients with end-stage renal disease (ESRD) on hemodialysis who have hypertension, ACE inhibitors or angiotensin receptor blockers (ARBs) are typically first-line medications, as they have been shown to decrease morbidity and mortality by reducing mean arterial pressure, left ventricular hypertrophy, and probably reduction of C-reactive protein and oxidant stress 3.
Medication Options
- Common options include lisinopril 2.5-10mg daily or losartan 25-50mg daily, which are effective in reducing blood pressure and have a beneficial effect on cardiovascular outcomes 4.
- Calcium channel blockers like amlodipine 5-10mg daily are also effective and well-tolerated, and can be used in combination with ACE inhibitors or ARBs to achieve better blood pressure control 5.
- Beta-blockers such as metoprolol 25-100mg twice daily can be particularly beneficial for patients with concurrent heart failure or coronary artery disease, as they reduce cardiac output and improve left ventricular function 3.
Medication Timing and Blood Pressure Goals
- Medication timing is crucial, and doses should be taken after dialysis sessions to prevent removal during treatment 4.
- Blood pressure goals should target predialysis values of <140/90 mmHg, as this has been shown to reduce the risk of cardiovascular morbidity and mortality 6.
Monitoring and Adjustments
- Regular monitoring of electrolytes, particularly potassium levels, is essential as these patients have limited kidney function to regulate electrolyte balance 3.
- The use of intensive hemodialysis has been shown to reduce blood pressure and the need for antihypertensive medications, and may be considered as an adjunctive treatment for patients with resistant hypertension 6.