Appropriateness of antihypertensive drug therapy in hemodialysis patients.

The prevalence and treatment of hypertension in hemodialysis (HD) patients exceeds 85% in the United States. Because of uncertainties in the evaluation of BP, it is unclear whether the HD patients who are being treated with medications are truly hypertensive. For ascertainment of the appropriateness of antihypertensive therapy, a prospective study in which antihypertensive drugs were discontinued in HD patients and 44-h interdialytic ambulatory BP monitoring was performed and left ventricular mass and inferior vena cava were measured by echocardiography was conducted. Home BP was monitored weekly during washout. An average of 2.3 medications were tapered and discontinued in 41 black participants (age 56 yr, 46% men, 54% diabetes, duration of dialysis 5.3 yr). Thirty-three (80%) of 41 patients became hypertensive, but eight (20%) remained normotensive at 3 to 5 wk. Patients who remained normotensive had a higher body mass index (31 versus 25.7 kg/m2) and diabetes (78 versus 45%), were less likely to smoke (13 versus 52%), had lower home BP at baseline (135/76 versus 147/85 mmHg), and had a lower left ventricular mass index (115 versus 146 g/m2). The rate of rise of home BP was more rapid in patients who became hypertensive. None of the normotensive patients were volume overloaded in contrast to 12% of the hypertensive patients. It is concluded that a majority of the treated black hypertensive patients are appropriately receiving therapy for hypertension. Those who have well-controlled home BP and no left ventricular hypertrophy may have a cautious withdrawal of their antihypertensive drugs.