Antihypertensive drug treatment and the risk for intra-hemodialysis hypotension

Key Points Antihypertensive medications are often used by hemodialysis patients, and intradialytic hypotension is a common complication in these patients. The study emulates a randomized clinical trial comparing antihypertensive drug treatment for the risk of hemodialysis hypotension in 4072 incident patients. Compared with calcium antagonists, β and α – β blockers, angiotensin converting enzyme inhibitors or angiotensin II antagonists, and diuretics may increase the risk of hemodialysis hypotension. Background Antihypertensive medications are often prescribed to manage hypertension in hemodialysis patients, and intradialytic hypotension (IDH) is a common complication in these patients. We investigated the risk of IDH in incident hemodialysis patients who initiated treatment with antihypertensive drugs in monotherapy. Methods The study was conducted as an emulation of a randomized clinical trial in 4072 incident hemodialysis patients who started antihypertensive drug treatment between January 2016 and December 2019. The primary outcome was the occurrence of IDH during hemodialysis sessions. The generalized estimating equation analysis was adjusted by inverse probability treatment weighting. Results Calcium channel blocker (CCB) use was associated with an IDH incidence rate of 7.4 events per person-year (95% confidence interval [CI], 6.2 to 8.6). Compared with CCB use, use of β and α – β blockers was strongly associated with a higher likelihood of IDH (odds ratio [OR] [95% CI, 2.27; 1.50 to 3.43]). The use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (OR [95% CI, 1.71; 1.14 to 2.57]) and diuretics (OR [95% CI, 1.52; 1.07 to 2.16]) were also associated with a higher likelihood of IDH compared with CCB use. Conclusions The study suggests that using β and α – β blockers, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and diuretics may increase the risk of IDH in hemodialysis patients compared with CCB use.