From the Guidelines
It is generally recommended to hold antihypertensive medications on dialysis days until after the dialysis session is completed, typically withholding them on the morning of dialysis and taking them after the session. This approach is based on the risk of hypotension during dialysis, as antihypertensive medications can compound the blood pressure-lowering effect of fluid removal during hemodialysis 1. The timing of antihypertensive medication administration should be individualized, taking into account interdialytic BP and the frequency of intradialytic hypotension 1.
Some key considerations include:
- The type of antihypertensive medication, as certain medications like ACE inhibitors, ARBs, beta-blockers, and calcium channel blockers may need to be withheld on dialysis days to avoid hypotension 1.
- The risk of intradialytic hypotension, which can be mitigated by withholding antihypertensive medications before dialysis 1.
- Individual patient factors, such as dialysis timing and specific medication properties, which may influence the decision to withhold or continue antihypertensive medications on dialysis days 1.
The effectiveness of withholding antihypertensive agents before dialysis in reducing intradialytic hypotension is still being investigated, with ongoing research aiming to provide more definitive guidance 1. However, based on current evidence, withholding antihypertensive medications on the morning of dialysis and taking them after the session is a reasonable approach to minimize the risk of hypotension and ensure patient safety. It is essential to follow personalized instructions from a nephrologist regarding medication schedules on dialysis days.
From the Research
Antihypertensive Medication Management
- The management of blood pressure in end-stage renal disease (ESRD) is complicated by various factors, including medication removal with dialysis 2.
- Antihypertensive medications are added if control of extracellular volume with ultrafiltration and dietary sodium restriction is inadequate 2.
- Medications that are removed with dialysis may be preferred in patients who are prone to develop intradialytic hypotension 2.
Holding Antihypertensive Medication Prior to Dialysis
- There is no specific recommendation on holding antihypertensive medication prior to dialysis day in the provided studies.
- However, it is mentioned that medications with a predominant renal excretion, such as lisinopril and atenolol, have a prolonged half-life in ESRD patients and can be administered thrice-weekly after dialysis to enhance blood pressure control 3.
General Antihypertensive Medication Administration
- The prescription of a drug for the treatment of hypertension should take into consideration the potency of the drug and the duration of action of the drug 4.
- A low dose of an angiotensin-converting enzyme (ACE) inhibitor has the same potency as a high dose but a shorter duration of action, which can cause blood pressure fluctuations if administered to a hypertensive patient 4.
- Combination therapy between calcium antagonists and beta-blockers or ACE inhibitors appears to be markedly effective and well tolerated in the treatment of hypertension 5.