From the Guidelines
The preferred blood pressure medication for dialysis patients is an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB), as they have been associated with decreased mortality in cohorts of CKD Stage 5 patients 1. When managing hypertension in dialysis patients, it's crucial to consider the pharmacokinetic and pharmacodynamic properties of the agents used.
- Lifestyle modifications, including salt restriction and achievement of dry weight, should be an integral part of the management plan.
- If lifestyle modifications are unsuccessful, antihypertensive drugs should be initiated, with ACE inhibitors or ARBs as the first line of treatment.
- The use of ACE inhibitors or ARBs has been shown to reduce left ventricular hypertrophy (LVH) in hemodialysis (HD) patients and may be more potent than ACE inhibitors alone 1. Key considerations for medication selection include:
- Dosing adjustments for kidney function
- Minimal impact of dialysis on the medication
- Addition of other medications, such as beta-blockers, for patients with heart failure or coronary artery disease
- Administration of medications after dialysis sessions to prevent removal during treatment
- Blood pressure targets of <140/90 mmHg for dialysis patients. The choice of ACE inhibitor or ARB should be based on individual patient characteristics and comorbidities, with the goal of minimizing cardiovascular risk and fluid overload complications common in dialysis patients 1.
From the Research
Blood Pressure Medication for Dialysis Patients
- The use of lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, has been studied in dialysis patients with hypertension 2, 3.
- Lisinopril has been shown to be effective in lowering blood pressure in dialysis patients, with a significant decrease in diastolic blood pressure observed in several studies 2, 3.
- The drug is generally well-tolerated, with few side effects reported, although hemoglobin levels may decrease in some patients 2.
- Lisinopril is removed by dialysis, with a mean ratio of post-/predialysis serum concentrations of 0.47 +/- 0.07 2.
- Other blood pressure medications, such as calcium channel blockers, may also be effective in dialysis patients, but the evidence is less clear 4.
- ACE inhibitors, including lisinopril, may be beneficial in patients with diabetes and hypertension, as they have been shown to have renoprotective effects and improve outcomes in these patients 5.
- However, the use of ACE inhibitors in dialysis patients requires careful monitoring, as they can cause hypotension and worsening renal function in some cases 6.