Resistant hypertension in end-stage kidney disease

J. Pharm. Pharmacogn. Res., vol. 10, no. 4, pp. 717-724, July-August 2022.

Short Communication

Usefulness of American College of Cardiology/American Heart Association treatment-resistant hypertension criteria among end-stage kidney disease patients – A case series

[Utilidad de los criterios de hipertensión resistente al tratamiento del Colegio Americano de Cardiología/Asociación Americana del Corazón entre pacientes con enfermedad renal en etapa terminal: Una serie de casos]

Shorouq Khader Abujadallah1, Seeba Zachariah1*, Rajaram Jagdale2,3

1College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates.

2Department of Nephrology, Thumbay University Hospital, Ajman, United Arab Emirates.

3College of Medicine, Gulf Medical University, Ajman, United Arab Emirates.

*E-mail: dr.seeba@gmu.ac.ae

Abstract

Context: American College of Cardiology/American Heart Association (ACC/AHA) antihypertensive treatment-resistance criteria have been not used in the hemodialysis (HD) population.

Aims: To assess interim Blood Pressure (BP) measures in End-Stage Kidney Disease (ESKD) patients on maintenance hemodialysis after classifying them using the ACC/AHA criteria.

Methods: The study was a case series assessing blood pressure readings of ESKD patients undergoing maintenance HD at a tertiary-level care hospital in the United Arab Emirates. Blood pressure readings before, during, and after HD sessions were collected and analyzed. SPSS version 26 was used for data analysis.

Results: Out of 55 patients with HD, 10 were classified as having treatment-resistant hypertension, and 6 had controlled hypertension in borderline based on mean post-dialysis Systolic BP (SBP) data of a month. Altogether, the patients underwent 183 dialysis sessions in a month with over 1000 BP readings. The treatment-resistant population showed a p-value less than 0.05 with elevated Pre-SBP, Post-SBP, Mean Intra-SBP, Mean Intra-diastolic BP (DPB), Pre-DBP, Post-DBP, Post-pulse pressure (PP), and Post-mean arterial pressure (MAP).

Conclusions: Use of ACC/AHA criteria for treatment-resistant hypertension might guide setting better treatment goals among ESKD patients on maintenance HD.

Keywords: antihypertensive; blood pressure control; hemodialysis; end-stage kidney disease; resistant hypertension.

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Resumen

Contexto: Los criterios de resistencia al tratamiento antihipertensivo del American College of Cardiology/American Heart Association (ACC/AHA) no se han utilizado en la población de hemodiálisis (HD).

Objetivos: Evaluar las medidas provisionales de presión arterial (PA) en pacientes con enfermedad renal en etapa terminal (ESKD) en hemodiálisis de mantenimiento después de clasificarlos utilizando los criterios ACC/AHA.

Métodos: El estudio fue una serie de casos que evaluó las lecturas de presión arterial de pacientes con ESKD que se sometieron a HD de mantenimiento en un hospital de atención terciaria en los Emiratos Árabes Unidos. Se recogieron y analizaron las lecturas de presión arterial antes, durante y después de las sesiones de HD. Para el análisis de datos se utilizó SPSS versión 26.

Resultados: De los 55 pacientes con HD, 10 se clasificaron con hipertensión resistente al tratamiento y 6 con hipertensión controlada en el límite en función de los datos de PA sistólica (PAS) media posdiálisis de un mes. En total, los pacientes se sometieron a 183 sesiones de diálisis en un mes con más de 1000 lecturas de PA. La población resistente al tratamiento mostró un valor de p inferior a 0,05 con pre-PAS, post-PAS, media intra-PAS, media intradiastólica (PAD), pre-PAD, post-PAD, presión post-pulso elevadas (PP), y post-presión arterial media (MAP).

Conclusiones: El uso de los criterios ACC/AHA para hipertensión resistente al tratamiento podría guiar el establecimiento de mejores objetivos de tratamiento entre los pacientes con ESKD en HD de mantenimiento.

Palabras Clave: antihipertensivos; control de la presión arterial; enfermedad renal terminal; hemodiálisis; hipertensión resistente.

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Citation Format: Abujadallah SK, Zachariah S, Jagdale R (2022) Usefulness of American College of Cardiology/American Heart Association treatment-resistant hypertension criteria among end-stage kidney disease patients – A case series. J Pharm Pharmacogn Res 10(4): 717–724.
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© 2022 Journal of Pharmacy & Pharmacognosy Research (JPPRes)