Lisinopril therapy for hemodialysis hypertension: Hemodynamic and endocrine responses

Agarwal, Rajiv; Lewis, Rebecca; Davis, Joyce L.; Becker, Bruce E.

doi:10.1053/ajkd.2001.29221

Cited by 64 publications

(50 citation statements)

References 29 publications

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“…This side effect is likely to occur when patients are taking a high dose of ACE inhibitor (50,51). Care should be taken to avoid the progression of anemia in dialysis patients given ACE inhibitors, because the drug metabolism is prolonged in patients with renal failure, as mentioned earlier (26). Progression of anemia is thought to promote cardiac hypertrophy in hemodialysis patients (52), but the imidapril group in this study showed reduction in LVM although the blood hemoglobin was reduced by the administration of imidapril.…”

Section: Bnpmentioning

confidence: 99%

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Effects of Imidapril on Left Ventricular Mass in Chronic Hemodialysis Patients

et al. 2006

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Left ventricular hypertrophy is considered to be a major cardiovascular risk factor in hemodialysis patients.Not only high blood pressure but also humoral factors such as angiotensin II and aldosterone are thought to contribute to the increase in left ventricular mass. We examined the effects of an angiotensin converting enzyme (ACE) inhibitor, imidapril, on left ventricular mass in patients with end-stage renal diseases on maintenance hemodialysis. Thirty patients on chronic hemodialysis were randomly divided into 2 groups of 15 patients each and given placebo or 2.5 mg imidapril once daily for 6 months. Before and after the 6-month period, left ventricular mass was evaluated by echocardiography, and circulating factors of the renin-angiotensin-aldosterone system were measured. Background characteristics such as age, gender ratio, causes of renal failure, duration of hemodialysis, body mass index and pre-dialysis blood pressure were comparable between the placebo and the imidapril groups. Systolic and diastolic blood pressures were not significantly changed in either group during the study period. In the imidapril group, serum ACE was reduced (12±1 to 5 ± 2 U/l, p <0.01) and plasma renin activity was increased (3.3 ± 0.8 to 8.1 ± 3.2 ng/ml/h, p <0.01), but plasma angiotensin II and aldosterone were not significantly changed after 6 months (13 ± 3 to 17 ± 3 pg/ml and 365 ± 125 to 312 ± 132 pg/ml, respectively). On the other hand, left ventricular mass index was signifi-

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Section: Bnpmentioning

confidence: 99%

“…with renal failure than in those without (26). However, it has been suggested that the blood pressure of hemodialysis patients may be more dependent on the degree of blood volume increase than on the activity of the RAAS (27,28).…”

Section: Bnpmentioning

confidence: 99%

Effects of Imidapril on Left Ventricular Mass in Chronic Hemodialysis Patients

et al. 2006

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“…High renin is one of the important contributory factor for the development of hypertension and other cardiovascular morbidity in the patient on haemodialysis and many clinical trials have demonstrated that angiotensin converting enzyme inhibitors are safe and effective in haemodialysis patients [23,24]. In our study angiotensin receptor blocker therapy provided best blood pressure control (in all phases of dialysis) with minimum intradialytic complications but their use were less and ACE inhibitors were not used at all which may be due to the fact that most of the ACE inhibitors are removed during haemodialysis.…”

Section: Anti-hypertensive Medication and Blood Pressure Control In Hmentioning

confidence: 99%

Efficacy of Various Antihypertensive Drugs in the Treatment of Hypertension in the Patients of End-Stage Renal Disease Leading to Haemodialysis- A Retrospective Study

Ahmad¹,

Rehman²,

Habib³

et al. 2017

J Nephrol Ther

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Introduction: Cardiovascular complications are the leading cause of morbidity and mortality in the patients of end-stage renal disease leading to hemodialysis. Majority of these patients suffers from hypertension and adequate control of blood pressure is a challenge in these patients because of multifactorial etiology and complicated pharmacokinetic changes in these patients. The present study aims is to find out the best possible drug or combination of drugs that can provide better control of blood pressure and improve the quality of life of these patients.

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“…Small patient cohort studies, either designed to characterise the pharmacokinetics of these drugs in ESRD patients or to specifically treat a hypertensive condition, have shown occasional brisk BP responses, frequently in response to low doses of these compounds. 11,15,16 It can be presumed that such responders have a more renin-dependent form of hypertension, although pre-therapy assessment of RAAS activity is not consistently done in many of these studies. Alternatively, if the ESRD-related hypertension is more volume-sensitive and presumably less renindependent, higher doses of an ACE-I or an ARB are probably needed to achieve the desired BP response.…”

Section: Treatment Of Hypertensionmentioning

confidence: 99%

“…Alternatively, if the ESRD-related hypertension is more volume-sensitive and presumably less renindependent, higher doses of an ACE-I or an ARB are probably needed to achieve the desired BP response. 15 Large, open-label trials, such as the Evaluation of the Losartan in Hemodialysis (ELHE) Study, have generally found significant reductions in pre-and post-dialysis systolic and diastolic BP. 17 Two pharmacokinetic properties are of particular relevance to the use of these drug classes in the ESRD patient: first, drug dialysance and second, systemic accumulation with repeat dosing.…”

Section: Treatment Of Hypertensionmentioning

confidence: 99%

Review: The pharmacokinetics and pharmacodynamics of angiotensin-receptor blockers in end-stage renal disease

Sica¹,

Gehr

2002

J Renin Angiotensin Aldosterone Syst

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Angiotensin-converting enzyme (ACE) inhibitors and more recently angiotensin-receptor blockers (ARBs) have become popular therapies in the end-stage renal disease (ESRD) patient. The ability of either of these drug classes to reduce blood pressure in the ESRD patient is well accepted; however, there is considerably less information available to guide the clinician in the safe and effective use of these drugs in the ESRD patient with congestive heart failure and/or coronary artery disease. Head-to-head studies in the ESRD patient are lacking for both drug classes. Several pharmacokinetic factors can influence the selection of these drugs, including dialysability and the propensity for systemic accumulation. ACE inhibitors (ACE-Is) and ARBs are recognised as having a range of nonpressor effects that are pertinent to patients with ESRD. Such effects include their ability to decrease both thirst drive and erythropoiesis. These drug classes, though, are distinguishable by the unique adverse effect profile for ACE-Is. As is the case in patients without renal failure, ESRD patients can experience cough and, less frequently, angioneurotic oedema with ACE-Is. In the ESRD population, so-called anaphylactoid dialyser reactions can occur in conjunction with ACE-I use. The use of a drug from within the ARB class carries both less risk and permits a compound with a preferred pharmacokinetic profile -limited dialysability and minimal systemic accumulation -to be administered. These attributes would favour the increased use of ARBs in this population.

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Lisinopril therapy for hemodialysis hypertension: Hemodynamic and endocrine responses

Cited by 64 publications

References 29 publications

Effects of Imidapril on Left Ventricular Mass in Chronic Hemodialysis Patients

Effects of Imidapril on Left Ventricular Mass in Chronic Hemodialysis Patients

Efficacy of Various Antihypertensive Drugs in the Treatment of Hypertension in the Patients of End-Stage Renal Disease Leading to Haemodialysis- A Retrospective Study

Review: The pharmacokinetics and pharmacodynamics of angiotensin-receptor blockers in end-stage renal disease

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