Department of Nephrology, Dr.RMLIMS, Vibhuti Khand, Gomti Nagar, Lucknow, 226010, India.
Department of Anaesthesiology, SGPGIMS, Rae Bareli Road, Lucknow, 226014, India.
Int Urol Nephrol. 2021 May;53(5):1007-1014. doi: 10.1007/s11255-020-02716-3. Epub 2021 Jan 2.
While use of carvedilol in patients on hemodialysis is encouraged with its low dialyzability, evidence supporting its superiority over metoprolol in improving the blood pressure control during dialysis is lacking. This study was undertaken to study the blood pressure variations in the peridialytic period after conversion from metoprolol to carvedilol.
In this this prospective, pre-post intervention study, patients on metoprolol were converted to carvedilol. Patients aged 18-65 years on biweekly dialysis with intradialytic rise in blood pressure {difference between pre- and post-dialysis systolic blood pressure > 10 mmHg with post-dialysis blood pressure of ≥ 130/80 mmHg} were recruited. The recorded blood pressure data post conversion to carvedilol was compared to the retrospective mean blood pressure recordings during metoprolol use.
Of the 48 subjects, the study mostly comprised young males (n-34, mean age- 37.06 ± 14.32 years). Both systolic and diastolic blood pressures at different time periods (pre-dialysis, intradialytic and post-dialysis) were significantly lower with carvedilol use than with metoprolol, p < 0.001. Mean pre-dialysis systolic blood pressures and diastolic blood pressures were 140.54 ± 7.68 and 84.42 ± 7.78 mmHg on carvedilol as compared to 148.12 ± 7.17 and 91.17 ± 6.97 mmHg on metoprolol (p < 0.001). Post-dialysis systolic blood pressures and diastolic blood pressures during Carvedilol regimen were better controlled at 147.42 ± 12.89 and 86.29 ± 7.31 mmHg, than 159.12 ± 8.18 and 97 ± 6.76 mmHg during metoprolol regimen (p < 0.001).
Our study has brought into focus the younger population at risk of peridialytic hypertension. Switch from metoprolol to carvedilol is an effective anti-hypertensive strategy in dialysis patients with poorly controlled peridialytic blood pressures. Carvedilol was well tolerated.
虽然卡维地洛的低透析清除率使其在血液透析患者中得到广泛应用，但缺乏证据表明其在改善透析期间血压控制方面优于美托洛尔。本研究旨在研究从美托洛尔转换为卡维地洛后透析期间血压的变化。
这是一项前瞻性、干预前后研究，在接受美托洛尔治疗的患者中转换为卡维地洛。纳入年龄在 18-65 岁之间、每两周透析一次且透析期间血压升高（透析前收缩压与透析后收缩压之差>10mmHg，透析后收缩压≥130/80mmHg）的患者。比较转换为卡维地洛后记录的血压数据与美托洛尔使用期间的回顾性平均血压记录。
在 48 名受试者中，研究主要包括年轻男性（n=34，平均年龄 37.06±14.32 岁）。与使用美托洛尔相比，使用卡维地洛时不同时间段（透析前、透析期间和透析后）的收缩压和舒张压均显著降低，p<0.001。使用卡维地洛时的平均透析前收缩压和舒张压分别为 140.54±7.68mmHg 和 84.42±7.78mmHg，而使用美托洛尔时分别为 148.12±7.17mmHg 和 91.17±6.97mmHg（p<0.001）。卡维地洛治疗方案的透析后收缩压和舒张压控制更好，分别为 147.42±12.89mmHg 和 86.29±7.31mmHg，而美托洛尔治疗方案分别为 159.12±8.18mmHg 和 97mmHg±6.76mmHg（p<0.001）。
我们的研究强调了透析期间血压控制不佳的年轻透析患者发生围透析期高血压的风险。从美托洛尔转换为卡维地洛是控制透析期间血压的有效降压策略。卡维地洛耐受良好。
