Beta-blockers Increase Cardiovascular Mortality in Hemodialysis Patients with Orthostatic Hypotension

BackgroundOrthostatic hypotension (OH) is prevalent among dialysis patients and is a known cardiovascular (CV) risk factor. Beta-blockers (BBs) are commonly prescribed to mitigate CV mortality in this population, despite potential risks associated with OH. This study examines the impact of BBs on CV mortality among dialysis patients with OH. MethodsWe conducted a prospective analysis of 134 dialysis patients from the PRECADIA program at the Centro de Educacion Medica e Investigaciones Clinicas (CEMIC), focusing on hemodynamic assessments including blood pressure changes from supine to standing positions, and evaluating CV mortality over a 3-year follow-up. OH was defined by a decrease of [≥]10 mmHg in diastolic blood pressure or [≥]20 mmHg in systolic blood pressure upon standing. Cox regression analyses were utilized to identify independent predictors of CV mortality. ResultsOf the patients, 23.1% were identified with OH. No significant differences in demographic or baseline clinical characteristics were observed between patients with and without OH, except for a higher diabetes prevalence in the OH group. OH patients treated with BBs demonstrated significantly higher CV mortality (29.6%) compared to those not receiving BBs. Independent predictors of CV mortality included age, time on dialysis, and BB use, with BBs significantly associated with increased CV mortality risk. ConclusionsDialysis patients with OH exhibit a high CV mortality rate, significantly influenced by BB usage. While BBs are recommended for managing CV risks in dialysis patients, their association with increased CV mortality in patients with OH necessitates careful consideration and management strategies.