Supervised atenolol therapy in the management of hemodialysis hypertension

Abstract

Supervised atenolol therapy in the management of hemodialysis hypertension.BackgroundUncontrolled hypertension continues to be a common problem, particularly in noncompliant hemodialysis patients. Atenolol, a water soluble β-blocker has a prolonged half-life in renal failure and may serve as a useful antihypertensive agent in these patients.MethodsHypertension was diagnosed by ambulatory blood pressure monitoring for 44hours during an interdialytic interval in eight chronic hemodialysis patients receiving no antihypertensive therapy. An average daytime blood pressure greater than 140/90mm Hg or an average nighttime blood pressure greater than 120/80mm Hg was used to define uncontrolled hypertension. Patients were then administered atenolol (25mg) following hemodialysis three times a week. The efficacy of therapy was judged by ambulatory blood pressure monitoring three weeks after instituting atenolol therapy. Blood pressure loads above the threshold blood pressures during the day or night were also calculated and compared before and after three weeks of atenolol therapy.ResultsThe mean 44-hour ambulatory blood pressure (ABP) fell from 144 ± 14/80 ± 7mm Hg to 127 ± 13/69 ± 10mm Hg (P < 0.001). The heart rate fell from 85 ± 11 to 70 ± 11 beats per minute. The systolic and diastolic blood pressure load was reduced from 71 ± 25% and 30 ± 24% to 35 ± 26% and 11 ± 17%, respectively (P < 0.001). There was a persistent antihypertensive effect over 44hours. The blood pressure reduction was achieved without any increase in intradialytic symptomatic or asymptomatic hypotensive episodes, reduction in delivered dialysis, or statistically significant changes in serum potassium or glucose.ConclusionsA supervised administration of atenolol following hemodialysis effectively and safely controls hypertension in chronic hemodialysis patients. This therapy can be particularly valuable for noncompliant hemodialysis patients