SP544EFFECTS OF NEBIVOLOL AND IRBESARTAN ON AMBULATORY BLOOD PRESSURE IN HEMODIALYSIS PATIENTS WITH INTRADIALYTIC HYPERTENSION: PRELIMINARY RESULTS FROM A RANDOMIZED CROSS-OVER STUDY

Abstract

INTRODUCTION AND AIMS: Blood pressure (BP) increase during or immediately after hemodialysis is an abnormal hemodynamic response to ultrafiltration and occurs in 5‐20% of patients. Intradialytic hypertension is associated with adverse clinical outcomes and is often poorly diagnosed and controlled. This study aimed to evaluate the effects of nebivolol and irbesartan in 24hour ambulatory BP in hemodialysis patients with intradialytic hypertension. METHODS: This is a randomized cross‐over pilot study in 31 hemodialysis patients (age: 61.3±11.6 years, male: 67.7%) with no clinical signs of volume overload. Intradialytic hypertension was defined as mean intradialytic rise ≥10 mmHg in systolic BP (SBP) over 6 consecutive hemodialysis sessions. After baseline evaluation, patients were randomly assigned to a single dose 1 hour before hemodialysis (n=16) or weekly intake (n=15) of nebivolol 5 mg and subsequently irbesartan 150mg, or vice versa. A two‐week wash‐out period took place before the initiation of the second drug. All patients underwent 24hour ambulatory BP monitoring with the Mobil‐O‐Graph device (IEM, Stolberg, Germany) over the relevant midweek session and the following 20hour interdialytic period. RESULTS: In total, 15 (48.4%) patients received nebivolol first and 16 (51.6%) received irbesartan first. Patients receiving a single dose of either nebivolol or irbesartan had lower post‐dialysis SBP and diastolic BP (DBP) [Baseline: 161.6±17.5/95.4±12.0; Nebivolol: 146.3±21.7 (p=0.004), 86.1±12.2 (p=0.001); Irbesartan: 146.4±32.0 (p=0.015), 86.6±19.6 (p=0.059) mmHg; respectively], non‐significantly lower 24‐hour SBP and lower DBP [Baseline: 148.8±19.6/86.9±11.8; Nebivolol: 142.8±20.4 (p=0.083), 83.7±12.3 (p=0.038); Irbesartan: 144.1±22.8 (p=0.144), 84.2±13.9 (p=0.174) mmHg]. Patients on weekly administration of either nebivolol or irbesartan had significantly lower post‐dialysis SBP and DBP (Baseline: 164.1±12.5/100.0±10.7 Nebivolol: 142.7±16.0 (p<0.001), 89.5±12.5 (p=0.004); Irbesartan: 144.9±24.3 (p=0.006), 88.2±13.6 (p=0.006) mmHg), significantly lower 24‐hour SBP and DBP (Baseline: 146.7±11.2/92.7±9.5 Nebivolol: 139.2±11.2 (p=0.003), 85.5±8.0 (p=0.003); Irbesartan: 142.0±16.6 (p=0.332), 86.3±10.4 (p=0.042) mmHg; accordingly) and significantly lower daytime and nighttime ambulatory SBP and DBP. CONCLUSIONS: This pilot study indicates that both nebivolol and irbesartan reduce post‐dialysis and 24‐hour BP in patients with intradialytic hypertension. Nebivolol seemed numerically more potent than irbesartan; permanent administration of these agents may be more effective than pre‐dialysis dosing.