Blood Pressure Drugs Protect Peritoneal Dialysis Patients from Heart Attack, Stroke

A pair of blood pressure medication classes can reduce the risk of heart attack and stroke in patients with end-stage renal disease (ESRD) who require peritoneal dialysis (PD).

A new study published inNephrology Dialysis Transplantationanalyzed data on 4879 patients with ESRD who had initiated PD between 2007 and 2011. Of those patients, about 2050 had filled a prescription for 1 of 2 classes of blood pressure medication: angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs).

After reviewing patient outcomes, the researchers determined that patients treated with either ACEIs or ARBs had a 16% reduced risk of strokes, heart attack, and death than those who weren’t prescribed either drug class.

These results are promising, as patients with ESRD are at greater risk for cardiovascular disease than those without the condition. For patients who require PD, mortality rates exceeded 20% in the first year that dialysis was initiated, and 42% of these deaths were linked to cardiovascular causes, according to the study authors.

“While randomized clinical trials are needed to test whether this is a causal relationship, these findings indicate doctors should consider using or restarting ACEIs and ARBs as first-line blood pressure medications for patients undergoing [PD],” said study author Jenny I. Shen, MD, in a press release.

However, the researchers noted that although dialysis patients commonly use ACEIs and ARBs, the prevalence of hypertension among this population suggests that the use of these medications remains suboptimal.

“These medications are often stopped when patients are in the late, but pre-dialysis, stages of kidney disease because of the risk of dangerously high potassium levels,” Dr. Shen stated. “The risk of higher potassium levels is minimized after patients have transitioned to [PD], but doctors often don’t resume the medication, even though it can usually be restarted safely.”

US hospitals are currently experiencing ashortageof the solution needed to perform PD.