Management of Hypertension in End-Stage Renal Disease
Pharmacological Interventions
- Carvedilol's combined alpha-1 and beta-blocking properties make it particularly effective for blood pressure control in patients with refractory hypertension, including those with ESRD, as recommended by the American Heart Association 1
- Dihydropyridine calcium channel blockers like amlodipine and felodipine are safe in patients with severe systolic heart failure, which is common in ESRD populations, according to the American College of Cardiology 2, 3
- When adding nifedipine to existing therapy, monitor for peripheral edema, which may be attenuated by concurrent use of ACE inhibitors or ARBs, as suggested by the European Society of Cardiology 4
Combination Therapy and Monitoring
- Avoid combining ACE inhibitors with ARBs in ESRD patients, as this increases adverse events (particularly hyperkalemia) without additional benefit, as stated by the American Heart Association 5, 6
- Do not use spironolactone or eplerenone if serum creatinine is ≥2.5 mg/dL in men or ≥2.0 mg/dL in women, or if serum potassium is ≥5.0 mEq/L, as recommended by the National Kidney Foundation 5, 7