Intradialytic Hypertension: Is pharmacological therapy effective? A prospective analysis

Introduction. Hypertension is very common in patients undergoing chronic hemodialysis (HD) with a prevalence of 70-80%, and only the minority has adequate blood pressure control. The dialysis procedure aids in hypertension management in most HD patients, inducing a reduction in blood pressure from the beginning to the end of the dialytic session due to ultrafiltration. However, a small percentage of patients usually manifest resistance to ultrafiltration with a paradoxal increase in blood pressure throughout dialysis, that is called intradialytic hypertension (IH). It occurs in around 10-15% of HD patients. Most episodes of IH are not severe or symptomatic, but in some cases intradialytic hypertension of any magnitude, in patients on maintenance hemodialysis, is associated with increased morbidity and mortality in short and long terms. There is no universally accepted definition of intradialytic hypertension according to literature. The most common criteria are the following: • increase in systolic blood pressure (SBP) >10 mmHg from pre to postdialysis • increase of mean arterial pressure (MAP) > 15 mmHg during or immediately after dialysis • an increase in blood pressure that is resistant to ultrafiltration. Even though definite evidence is not yet available, optimal blood pressure in dialysis patients is not different from recommendations for the general population. Pathophysiology Although this hemodialysis complication has long been recognized, the pathophysiology of IH is not well-defined. Many hypotheses have been proposed to explain this paradoxal phenomenon, which is likely multifactorial. Recent studies and reports highlight the important role of fluid overload, positive sodium balance, activation of the renin-angiotensin-aldosterone system (RAAS), sympathetic overactivity, hemodynamic changes, hemodialytic removal of antihypertensives, endothelial cell dysfunction, erythropoietin stimulating agents (ESA). Because of the proposed multifactorial pathophysiology, IH presents several targets for intervention. So. the appropriate management of this hemodialysis' complication becames a challenge. Aim In our study we are going to evaluate the prevalence of IH in our hemodyalisis centre and to compare effectiveness of two different antihypertensive therapies, b-blockers and ACE-inhibitors in the management of intradyalitic hypertension. Methods. We conducted a monocentric prospective randomised study at Dialysis Centre of Istituti Clinici Scientifici Maugeri for the period of time from October 2021 to January 2022.