Which Drugs Are Associated Most Closely with Hypotension During Hemodialysis?

Symptomatic hypotension is a troublesome adverse effect of hemodialysis, but evidence of risks for intradialytic hypotension associated with different antihypertensive drug classes is limited. In this study, researchers used a 7-country European hemodialysis database to identify ≈4000 patients who began monotherapy with an antihypertensive drug after beginning dialysis. Subsequent incidence of intradialytic hypotension (i.e., nadir systolic blood pressure <90 mm Hg during a session) was compared across drug classes.

Findings were as follows:

• Unadjusted incidence rates of intradialytic hypotension per person-year were 7.4 with calcium-channel blockers (CCBs), 7.8 with angiotensin-converting–enzyme (ACE) inhibitors or angiotensin-receptor block…