Abstract: TH-PO0310
Blood Pressure Medication Use Patterns and All-Cause Mortality in Hemodialysis
Session Information
- Hypertension and CVD: Clinical - 1
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Etemadi, Ali, Stanford University School of Medicine, Stanford, California, United States
- Liu, Sai, Stanford University School of Medicine, Stanford, California, United States
- Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
- Montez-Rath, Maria E., Stanford University School of Medicine, Stanford, California, United States
- Chang, Tara I., Stanford University School of Medicine, Stanford, California, United States
Background
The optimal approach to blood pressure (BP) management during the transition to hemodialysis (HD) is unclear. We examined how changes in ACEi/ARB, beta-blockers (BB), and calcium channel blocker (CCB) use patterns during this period associated with 1 and 3 year survival among older patients who survived ≥6 months post-HD.
Methods
Using data from the USRDS linked to a large dialysis organization, we included patients ≥66 years with a history of hypertension who initiated HD from 2007-2011. We restricted the cohort to patients who survived ≥6 months post-HD, i.e., the beginning of follow-up time. We required continuous Medicare AB and D coverage for ≥18 and ≥15 months before the start of follow-up. Less than one month of prescription was considered evidence of non-use, and ≥80% indicated adherence. For each of the three BP medications, using the 6 months pre-HD and post-HD periods, we defined patients as: never users (no use throughout), initiators (started/ increased use post-HD), discontinuers (stopped/ decreased use post-HD), and consistent users (adherent throughout). We used Cox models adjusting for demographics, dialysis access type, Elixhauser comorbidity index, hospitalized days, BP, BP variability, and labs (Kt/V, albumin, calcium, hemoglobin) measured during the 12-month pre- to 6-month post-HD period.
Results
Of the 11,415 patients in the cohort, mean age was 76±7 years and 56% were female. No significant associations of ACEi/ARB or BB use patterns with mortality were observed. For CCB, compared with never users, consistent users had a lower risk of death at 1- and 3- years, while initiators displayed a lower risk of death only at 3-years. Discontinuers showed no association with death (Table).
Conclusion
Among older patients who survived to 6 months post-HD, initiating or consistently using CCBs was associated with improved survival compared to patients who never used CCB. No significant associations were observed for ACEi/ARB and BB use patterns.
Funding
- Private Foundation Support