Additional Evening-Dose Oral Antihypertensives Improves Blood Pressure (BP) Profiles in Hemodialysis(HD) Day without Affecting Intradialytic Hypotensive Episodes

초록

In many HD patients, antihypertensives are skipped in the HD day morning to avoid intradialytic hypotension. Adequate BP control in these patients is difficult because they have also the limitation in achieving adequate dry weight. We hypothesized that the addition of an intermediate-acting oral antihypertensive in the evening before HD day improves BP profiles during HD day by reducing baseline BP without affecting intradialytic hypotensive episodes. Eleven patients (5 male, 6 female; 52+/-3 years) who skipped antihypertensives in the HD day morning due to frequent intradialytic hypotension but whose pre-HD morning systolic BP were above 160 mmHg underwent alternately a 2-week with and a 2-week without additional evening-dose oral antihypertensive. Sustained releasing (12-hour) nicardipine (titered up to 45mg) was added to evening antihypertensive medication (6pm-8pm). Pre-, post-HD and nadir BP and intradialytic hypotensive episodes were recorded in each HD session and 24-hour BP profiles were monitored at the last HD day of each period using ambulatory BP monitor.During each period, total ultrafiltration and post HD weight was same (3.1 +/- 0.4 vs, 2.9 +/- 0.3 L, 56.1 +/- 0.3, vs. 55.9 +/- 0.4 kg, period without evening dose vs. period with evening dose respectively, Mean +/- SEM). Pre-HD systolic BP (measured at 6 A.M, mmHg) decreased significantly from 169.4 +/- 11.8 to 151.0 +/- 9.1(p<0.05) after an addition of evening dose. Pre-HD diastolic BP also decreased 98.2 +/- 8.2 to 86.3 +/- 9.9 but without significance. Post-HD BP showed no significant changes (151.3 +/- 9.7 vs. 141.1 +/- 10.5, 91.7 +/- 6.8 vs. 83.2 +/- 6.1). Importantly, nadir BP during HD session (mmHg) did not decreased significantly after an addition of evening dose (119.5 +/- 13.9 vs. 111.3 +/- 14.3, 69.3 +/- 12.8 vs. 62.3 +/- 13.4) and intradialytic hypotensive episodes (0.18 +/- 0.12 vs. 0.19 +/- 0.17 episodes/session). In the result of 24-hour ambulatory BP monitor, mean daytime systolic and