Antihypertensive Agents in the Dialysis Patient

  • Michelle A. FravelEmail author
  • Elizabeth Bald
  • Mony Fraer
Antihypertensive Agents: Mechanisms of Drug Action (Michael E. Ernst, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Antihypertensive Agents: Mechanisms of Drug Action


Purpose of Review

Hypertension and antihypertensive drug utilization are remarkably prevalent in ESRD patients. Management of blood pressure elevation in this population is complicated by many factors, including a multidimensional etiology, challenges in obtaining accurate and appropriately timed blood pressure measurements, highly specific drug dosing requirements, and a paucity of outcomes-based evidence to guide management decisions. The purpose of this review is to summarize and apply knowledge from existing clinical trials to enhance safe and effective use of antihypertensive agents in dialysis patients.

Recent Findings

Two meta-analyses have established the benefit of antihypertensive therapy in ESRD. Data supporting the use of one antihypertensive class over another is less robust; however, beta-blockers have more clearly demonstrated improved cardiovascular outcomes in prospective randomized trials. Interdialytic home blood pressure monitoring has been demonstrated to be better associated with cardiovascular outcomes than clinic pre- or post-dialysis readings and should ideally be considered as a routine part of blood pressure management in this population.


As data from small trials provides limited guidance for the management of hypertension in ESRD, more research is needed to guide medication selection and utilization. Specifically, large prospective randomized trails comparing cardiovascular outcomes of various medication classes and differing blood pressure targets are needed.


Hypertension Hemodialysis Chronic kidney disease Antihypertensive agents 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Michelle A. Fravel
    • 1
    Email author
  • Elizabeth Bald
    • 2
  • Mony Fraer
    • 3
  1. 1.Department of Pharmacy Practice and Science, College of PharmacyThe University of IowaIowa CityUSA
  2. 2.Department of Pharmaceutical CareUniversity of Iowa Hospitals and ClinicsIowa CityUSA
  3. 3.Division of Nephrology and Hypertension, Department of Internal Medicine, Carver College of MedicineThe University of IowaIowa CityUSA

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