(B15) Use of Different Antihypertensive Drugs and Risk of Intradialytic Hypotension in Patients Undergoing Hemodialysis

Publication Number: 627

Background: Intradialytic hypotension (IDH) is a frequent and serious complication of hemodialysis that increases the mortality of patients undergoing hemodialysis (HD). Changes in blood pressure might be modified by the use of antihypertensive (anti-HTN) drugs in these patients. However, the relationship between different anti-HTN drugs and the risk of IDH remains limited.

Objectives: To evaluate the association between different types of anti-HTN drugs and IDH risk in HD patients

Methods: We performed a retrospective cohort study at National Cheng Kung University Hospital, including new dialysis patients over 20 years old who had ever received anti-HTN drugs during the study period (2016-2021). We identified all sessions within a three-year period starting from the patient's first day of dialysis and excluded the initial 90-day sessions for each patient. Outcomes of interest were IDH, defined as the occurrence of systolic blood pressure (SBP) < 90 mmHg (100 mmHg if pre-dialysis SBP ≥ 160 mmHg) during HD. Exposure was defined by the use of different anti-HTN drugs (alpha-blockers [AB], angiotensin-converting enzyme inhibitors/angiotensin receptor blockers [ACEI / ARB], beta-blockers [BB], or dihydropyridine calcium channel blockers [DHP-CCB]) on the hemodialysis date. The analytical unit was HD sessions. We applied generalized linear mixed model to account for data dependency resulting from the same individuals. We calculated odds ratio (OR) and 95% confidence interval (CI) of IDH for exposure versus non-exposure of each drug class. We collected patient demographics, comorbidities (hypertension, diabetes, coronary artery disease), dialysis records (pre-HD BP, ultrafiltration weight to dry weight ratio, blood flow, dialysate flow rate), and comedications (vasodilators, midodrine, erythropoietin-stimulating agents) for covariates adjustment in the model.

Results: We identified 116 patients with 39,371 HD sessions. 60.0% of all included sessions involved male patients, and the mean age of included patients was 61.4 years. Of these sessions, 8.5% were exposed to AB, 23.7% were exposed to ACEI/ARB, 31.7% were exposed to BB, and 33.6% were exposed to DHP-CCB. Compared to not-exposed sessions, we found the adjusted OR of IDH was 0.44 (95% Cl, 0.29-0.66) for AB, 1.00 (95% Cl 0.81-1.23) for ACEI / ARB, 0.97 (95% Cl 0.81-1.14) for BB, and 0.70 (95% Cl 0.59-0.83) for DHP-CCB.

Conclusions: We found risk of IDH differed between different classes of anti-HTN drugs. Exposure to AB and DHP-CCB were associated with lower odds of IDH when compared to non-exposure to AB and DHP-CCB, respectively. Treatment of BB and ACEI/ARB appeared to yield neutral effect on the risk of IDH. For clinical practice, our study could provide informative suggestions regarding anti-HTN drug adjustment in HD patients.