Among dialysis patients with hypertension and thickened heart muscles, certain antihypertensive medications are better than others for preventing cardiovascular disease and hospitalizations, according to an abstract, "Hypertension in Hemodialysis Patients Treated with Atenolol or Lisinopril (HDPAL): A Randomized Controlled Trial" (Abstract 5826), presented at the American Society of Nephrology's Kidney week 2013. A team led by Rajiv Agarwal, MD, MBBS, FASN, from the VA Medical Center in Indianapolis, conducted a clinical trial to assess the safety and efficacy of an ACE inhibitor–based antihypertensive treatment compared with a β-blocker-based antihypertensive treatment. Two hundred patients on hemodialysis who had hypertension and thickened heart muscles were randomized to the ACE inhibitor lisinopril or the β-blocker atenolol, each administered three times weekly after dialysis.
Blood pressure improved over time in both groups, and no statistical difference between drugs was noted. An independent data safety monitoring board recommended termination of the study due to safety concerns. Serious cardiovascular events occurred in 14 patients in the atenolol group and 26 patients in the lisinopril group. Hospitalizations for heart failure and other causes were worse in the lisinopril group.
“Contrary to the original hypothesis, the trial found that among kidney dialysis patients with hypertension and thickening of heart muscles, atenolol-based antihypertensive therapy may be superior to lisinopril-based therapy in preventing cardiovascular disease such as heart failure and heart attacks as well as all-cause hospitalizations,” said Dr. Agarwal.