NEW YORK (Reuters Health) – Hypertension in chronic hemodialysis patients can be controlled by the ACE inhibitor lisinopril given three times weekly after hemodialysis, according to a report published in the December issue of the American Journal of Kidney Diseases.
Dr. Rajiv Agarwal, from Indiana University in Indianapolis, and colleagues tested the thrice-weekly lisinopril regimen in 11 chronic hemodialysis patients with hypertension. The lisinopril dose was adjusted at biweekly intervals to achieve a blood pressure goal of 140/90 mmHg during the day and less than 120/80 mmHg at night.
Four patients required 10 mg of lisinopril per session, five required 20 mg, and 2 required 40 mg. If blood pressure control is not achieved, ultrafiltration can be used to enhance the hemodynamic response, the authors point out, but only one patient required ultrafiltration in the current study.
After a 2-week run-in phase, the average blood pressure between dialysis periods decreased from 149/84 mm Hg before lisinopril to 127/73 mmHg after the regimen was initiated. At the final visit, only two patients had systolic hypertension and one patient had diastolic hypertension.
Lisinopril therapy was not tied to an increase in intradialytic hypotensive episodes. The authors believe that this may be due to the drug's rapid dialyzability.
Dialysis and lisinopril therapy were linked to an increase in plasma renin activity, the investigators report. "The increase in plasma renin activity after exposure to lisinopril…suggests that kidneys that have lost excretory function are still able to respond to angiotensin-converting enzyme (ACE) inhibition by increasing plasma renin activity."
Randomized controlled trials are needed to determine if ACE inhibitors can reduce the cardiovascular event rate in chronic hemodialysis patients, the researchers conclude.
Am J Kidney Dis 2001;38:1245-1250.
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