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Evaluation of management and factors associated with hypertension control in hemodialysis patients at a tertiary-care hospital in Pakistan

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Abstract

Background

Hypertension is highly prevalent and poorly controlled among hemodialysis patients. However, published information regarding the management and control of hypertension among Pakistani hemodialysis patients is scarce.

Objective

Our objective was to evaluate the pharmacotherapeutic management and control of hypertension and associated factors in hemodialysis patients at a tertiary-care hospital.

Materials and methods

Eligible hypertensive hemodialysis patients enrolled at the Balochistan Institute of Nephrology-Urology Quetta, Pakistan, between 1 July 2017 and 30 November 2019 were retrospectively followed for 6 months after the baseline hemodialysis session. Collected data were analyzed using SPSS version 20, and odds ratios (ORs) were calculated. Patients with mean pre-dialysis blood pressure (BP) < 140/90 and post-dialysis BP < 130/80 mmHg in the final month of study were classified as being at target BP.

Results

A total of 237 hypertensive hemodialysis patients were included in the analysis. The mean age of patients was 42.8 ± 13.2 years, and most (78.9%) had at least one comorbidity. In the final month of the study, only 68 patients (28.7%) were at target BP. Patients were treated with a median of two antihypertensive drugs (range 1–5). Calcium-channel blockers (CCBs) were the most commonly prescribed antihypertensive (54.4%), followed by angiotensin-receptor blockers (53.2%) and diuretics (42.2%). In multivariate binary logistic regression analysis, the use of diuretics (OR 0.50; 95% CI 0.27–0.95), CCBs (OR 2.90; 95% CI 1.35–6.20), β-blockers (OR 2.9; 95% CI 1.30–6.73), and α/β-blockers (OR 2.75; 95% CI 1.26–5.98) was significantly associated with hypertension control.

Conclusion

Hypertension control was suboptimal at the study site. A notable proportion of patients were receiving diuretics despite guidelines discouraging their use. The use of β-blockers, α-β-blockers, and CCBs was associated with hypertension control.

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Acknowledgements

The authors acknowledge the record keeping and supportive staff of Balochistan Institute of Nephrology-Urology Quetta for their help in conducting this study.

Funding

No funding was received.

Author information

Authors and Affiliations

  1. Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan

    Gulalai, Nafees Ahmad & Abdul Wahid

  2. Department of Pharmacy, Quaid-i-Azam University Islamabad, Islamabad, Pakistan

    Amjad Khan & Asad Khan

  3. Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan

    Muhammad Atif

Authors
  1. Gulalai
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  2. Nafees Ahmad
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  3. Abdul Wahid
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  4. Amjad Khan
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  6. Asad Khan
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Contributions

G, NA, and AW conceptualized the study. G collected the data. G, MA, Asad K and NA analyzed the data and wrote the manuscript. All authors critically reviewed the manuscript. NA also supervised the study.

Corresponding author

Correspondence to Nafees Ahmad.

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Conflict of interest

Gulalai, Nafees Ahmad, Abdul Wahid, Amjad Khan, Muhammad Atif, and Asad Khan have no conflicts of interest that are directly relevant to the content of this article.

Ethics approval

The study was approved by the Research and Ethics Committee of the Faculty of Pharmacy and Health Sciences, and permission to conduct the study was granted by BINUQ.

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Gulalai, Ahmad, N., Wahid, A. et al. Evaluation of management and factors associated with hypertension control in hemodialysis patients at a tertiary-care hospital in Pakistan. Drugs Ther Perspect 36, 396–403 (2020). https://doi.org/10.1007/s40267-020-00763-5

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  • DOI: https://doi.org/10.1007/s40267-020-00763-5

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