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Abstract: SA-PO519

Additive Risk for Pericardial Effusion of Exposure to Either Hydralazine or Minoxidil and Advanced CKD

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical


  • Zlaket, Giovanni, Ochsner Health, New Orleans, Louisiana, United States
  • Jordan, Hannah Tram Anh Ha, Ochsner Health, New Orleans, Louisiana, United States
  • Kovacic, Rosemary, Ochsner Health, New Orleans, Louisiana, United States
  • Velez, Juan Carlos Q., Ochsner Health, New Orleans, Louisiana, United States

Vasodilatory antihypertensives hydralazine and minoxidil have been linked to the development of pericardial effusion. However, most of the available evidence comes from small cohort studies or case series. Furthermore, because advanced chronic kidney disease (CKD) is associated with uremic pericardial effusion, it is not clear whether hydralazine or minoxidil independently confer a risk for pericardial effusion in advanced CKD. We aimed to examine this question in a large patient database.


We retrospectively reviewed records of adult patients who underwent transthoracic echocardiography (TTE) between 2017 and 2022 to identify those diagnosed with pericardial effusion. Exposure to either hydralazine or minoxidil within 3 months prior to the TTE was probed, as well as demographic and clinical characteristics, including CKD status. Advanced CKD included stage 4 or 5 CKD or end-stage kidney disease. Cases of mesothelioma or tuberculosis were excluded.


A total of 153,678 unique patients with TTE entered the analysis. Pericardial effusion was found in 1,441 (0.94%). By multivariate logistic regression, exposure to hydralazine [OR 1.58 (CI 1.4–1.8), p<0.0001)], exposure to minoxidil [OR 4.48 (CI 2.8–7.2), p<0.0001)], advanced CKD [OR 2.30 (CI 1.7–3.1), p<0.0001)], coronary artery disease [OR 1.21 (CI 1.1–1.4), p=0.0011)], and female sex [OR 1.33 (CI 1.2–1.5), p<0.0001)], were independently associated with increased risk of pericardial effusion, whereas age, race, diabetes mellitus and hypertension were not. The rate of pericardial effusion was greater in those exposed to vasodilators: 1.4% of hydralazine users (n=24,650) compared to 0.8% of nonusers (n=121,118) (p<0.0001), and 5.4% of minoxidil users (n=354) compared to 0.9% of nonusers (n=153,414) (p<0.0001). Among those with advanced CKD (n=2,337), the incidence of pericardial effusion was overall higher and significantly associated with exposure to either hydralazine (3.3% vs 1.7% for nonusers, p=0.022) or minoxidil (6.5% vs 2.1% for nonusers, p=0.043).


Hydralazine and minoxidil confer an increased risk for pericardial effusion that augments the increased risk associated with advanced CKD. Because these agents are frequently prescribed in advanced CKD, close monitoring is advised.