Intradialytic Hypertension
Conditions
Keywords
Intradialytic Hypertension, Hemodialysis, Hypertension, Extracellular Volume, Endothelial Cell Dysfunction, Endothelin 1, Carvedilol
Brief summary
The purpose of this study is 1) to determine what physiologic factors (extracellular fluid overload or vasoconstriction) contribute more to increased blood pressure levels between dialysis treatments in hemodialysis patients whose blood pressure increases and decreases during hemodialysis and 2) to determine whether carvedilol provides better control of blood pressure between dialysis treatments than prazosin in patients whose blood pressure increases during dialysis.
Interventions
DRUGCarvedilol vs. Prazosin
Sponsors
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
University of Texas Southwestern Medical Center
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
(for Aims 1 and 2): * age more than 18 years * Hypertension defined as systolic blood pressure more than 140 mmHg before dialysis or more than 130 mmHg after dialysis * For case subjects with intradialytic hypertension: systolic blood pressure increase more than 10 mmHg from pre to post dialysis in at least 4 out of 6 screening treatments * For control subjects: systolic blood pressure decrease more than 10 mmHg from pre to post dialysis in at least 4 out of 6 screening treatments Inclusion criteria for Aim 3 includes the case subjects described above.
Exclusion criteria
For Aims 1 and 2: * Hemodialysis vintage less than 1 month * Amputated arm or leg * Presence of cardiac defibrillator or pacemaker * Presence of large metal prosthesis * Failure to achieve dry weight For Case subjects participating in Aim 3: * Patients with a specific indication for beta blocker therapy including systolic heart failure, history of myocardial infarction, history of tachyarrhythmia or angina being managed with beta blocker therapy. * Patients with contraindications to beta blockade including bradycardia (heart rate less than 60 beats per minute) while not on a pulse lowering drug, severe reactive airway disease, prior intolerance to beta blocker therapy * Prior intolerance to alpha blocker therapy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Ratio of Extracellular Body Water to Total Body Water | Expected recruitment is 4-5 years |
Secondary
| Measure | Time frame |
|---|---|
| Change in Endothelin-1 from pre to post dialysis | Expected recruitment is 4-5 years |
Other
| Measure | Time frame |
|---|---|
| Change in Vascular Resistance from pre to post dialysis | Expected recruitment is 4-5 years |
| Change in Asymmetric Dimethylarginine From pre to post dialysis | Expected recruitment is 4-5 years |
| Change in Angiotensin II from pre to post dialysis | Expected recruitment is 4-5 years |
Countries
United States
Outcome results
None listed