Abhilash Chandra1, Namrata Rao2, Divya Srivastava3, Prabhaker Mishra4. 1. Department of Nephrology, Dr.RMLIMS, Vibhuti Khand, Gomti Nagar, Lucknow, 226010, India. 2. Department of Nephrology, Dr.RMLIMS, Vibhuti Khand, Gomti Nagar, Lucknow, 226010, India. jrambo3636@gmail.com. 3. Department of Anaesthesiology, SGPGIMS, Rae Bareli Road, Lucknow, 226014, India. 4. Department of Biostatistics and Health Informatics, SGPGIMS, Rae Bareli Road, Lucknow, 226014, India.
Abstract
BACKGROUND: While use of carvedilol in patients on hemodialysis is encouraged with its low dialyzability, evidence supporting its superiority over metoprolol in improving the blood pressure control during dialysis is lacking. This study was undertaken to study the blood pressure variations in the peridialytic period after conversion from metoprolol to carvedilol. MATERIALS AND METHODS: In this this prospective, pre-post intervention study, patients on metoprolol were converted to carvedilol. Patients aged 18-65 years on biweekly dialysis with intradialytic rise in blood pressure {difference between pre- and post-dialysis systolic blood pressure > 10 mmHg with post-dialysis blood pressure of ≥ 130/80 mmHg} were recruited. The recorded blood pressure data post conversion to carvedilol was compared to the retrospective mean blood pressure recordings during metoprolol use. RESULTS: Of the 48 subjects, the study mostly comprised young males (n-34, mean age- 37.06 ± 14.32 years). Both systolic and diastolic blood pressures at different time periods (pre-dialysis, intradialytic and post-dialysis) were significantly lower with carvedilol use than with metoprolol, p < 0.001. Mean pre-dialysis systolic blood pressures and diastolic blood pressures were 140.54 ± 7.68 and 84.42 ± 7.78 mmHg on carvedilol as compared to 148.12 ± 7.17 and 91.17 ± 6.97 mmHg on metoprolol (p < 0.001). Post-dialysis systolic blood pressures and diastolic blood pressures during Carvedilol regimen were better controlled at 147.42 ± 12.89 and 86.29 ± 7.31 mmHg, than 159.12 ± 8.18 and 97 ± 6.76 mmHg during metoprolol regimen (p < 0.001). CONCLUSION: Our study has brought into focus the younger population at risk of peridialytic hypertension. Switch from metoprolol to carvedilol is an effective anti-hypertensive strategy in dialysis patients with poorly controlled peridialytic blood pressures. Carvedilol was well tolerated.
BACKGROUND: While use of carvedilol in patients on hemodialysis is encouraged with its low dialyzability, evidence supporting its superiority over metoprolol in improving the blood pressure control during dialysis is lacking. This study was undertaken to study the blood pressure variations in the peridialytic period after conversion from metoprolol to carvedilol. MATERIALS AND METHODS: In this this prospective, pre-post intervention study, patients on metoprolol were converted to carvedilol. Patients aged 18-65 years on biweekly dialysis with intradialytic rise in blood pressure {difference between pre- and post-dialysis systolic blood pressure > 10 mmHg with post-dialysis blood pressure of ≥ 130/80 mmHg} were recruited. The recorded blood pressure data post conversion to carvedilol was compared to the retrospective mean blood pressure recordings during metoprolol use. RESULTS: Of the 48 subjects, the study mostly comprised young males (n-34, mean age- 37.06 ± 14.32 years). Both systolic and diastolic blood pressures at different time periods (pre-dialysis, intradialytic and post-dialysis) were significantly lower with carvedilol use than with metoprolol, p < 0.001. Mean pre-dialysis systolic blood pressures and diastolic blood pressures were 140.54 ± 7.68 and 84.42 ± 7.78 mmHg on carvedilol as compared to 148.12 ± 7.17 and 91.17 ± 6.97 mmHg on metoprolol (p < 0.001). Post-dialysis systolic blood pressures and diastolic blood pressures during Carvedilol regimen were better controlled at 147.42 ± 12.89 and 86.29 ± 7.31 mmHg, than 159.12 ± 8.18 and 97 ± 6.76 mmHg during metoprolol regimen (p < 0.001). CONCLUSION: Our study has brought into focus the younger population at risk of peridialytic hypertension. Switch from metoprolol to carvedilol is an effective anti-hypertensive strategy in dialysis patients with poorly controlled peridialytic blood pressures. Carvedilol was well tolerated.
Authors: R L Lins; M Elseviers; P Rogiers; R J Van Hoeyweghen; H De Raedt; P Zachee; R A Daelemans Journal: Clin Nephrol Date: 1997-07 Impact factor: 0.975