Long-Term Control of Hypertension in Dialysis Patients by Low Dose Atenolol

Abstract

Hypertension in dialysis patients is considered a major factor in cardiovascular mortality. We investigated long-term efficacy of intermittent atenolol (AT) administration in 10 (7M/3F) hypertensive dialysis patients, age 60.5 (38–72), on dialysis for 56.5 months (8–156) thrice per week (10.5–13.5 h/w) (A). A similar group of 11 normotensive patients served as controls (B). Hypertension was defined as BP>140/90 (day) and >120/80 mmHg (night) by a 44-h ambulatory BP monitoring (ABPM) after the mid-week session. Dialysis ultrafiltration, hematology, biochemistry were similar in A and B. Atenolol was started on an alternate day, 37.5 mg/w and increased as needed. After 34 days (6–80) and a dose of 68.75 (37.5–450) mg/w, BP dropped (ABPM: MAP 104±11.5 to 95.6±10.4 mmHg, P=0.0025) similar to controls and daytime HR dropped: 84.6±9.2 to 69.3±8.2, P=0.0008 and at night: 79.5±7.6 to 68.6±8.6 b/1' becoming lower than in B: 83±10.8/69.3±8.2, P=0.009 and 80.5±11.7/68.6±8.6 b/1' (P=0.02). Six months later ABPM in A as well as echocardiography in A and B remained unchanged. Moderate, volume independent hypertension in stable dialysis patients is easily controlled during the interdialytic period by small intermittent atenolol doses.