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Sep 01, 2023

Study: Alpha blockers seen as safe for blood pressure control in patients on dialysis

Iseri K, et al. Kidney Med. 2023;doi:10.1016/j.xkme.2023.100698. Iseri K, et al. Kidney Med. 2023;doi:10.1016/j.xkme.2023.100698. Alpha blockers may be safe to prescribe to help lower blood pressure

Iseri K, et al. Kidney Med. 2023;doi:10.1016/j.xkme.2023.100698.

Iseri K, et al. Kidney Med. 2023;doi:10.1016/j.xkme.2023.100698.

Alpha blockers may be safe to prescribe to help lower blood pressure in patients on hemodialysis, according to study findings.

The results of the Japanese study back up the safety of what is usually reserved as a second-line hypertension therapy, which clinicians are “hesitant” to prescribe after some studies have tied alpha blockers to increased fall and fracture risks, Ken Iseri, MD, PhD, and colleagues wrote in Kidney Medicine.

“This could potentially broaden the range of antihypertensive therapies considered safe for use in hemodialysis patients, thus having a direct impact on patient care and treatment strategies,” Iseri told Healio, adding that the findings suggest alpha blockers “may even have a mortality-preventive effect in certain subpopulations.”

Drawing on data from the Japan-Dialysis Outcomes and Practice Patterns Study, they analyzed findings for 5,149 patients on hemodialysis (68% were men, mean age 65 years) receiving more than one antihypertensive agent. Of those patients, 14% (n = 717) received alpha blockers (doxazosin mesylate, bunazosin hydrochloride, prazosin hydrochloride and urapidil hydrochloride) along with at least one other antihypertensive medication.

Researchers looked at risks of falls, fractures or all-cause death as primary outcomes with the use of alpha blockers vs. use of other antihypertensive drugs.

During a mean follow-up of 2 years, patients taking alpha blockers had no significant increased risk for fractures (HR = 0.92; 95% CI, 0.61-1.38) compared with those not taking alpha blockers. Likewise, there were no significantly increased risks of falls (HR = 0.94; 95% CI, 0.74-1.20) or all-cause death (HR = 0.87; 95% CI, 0.64-1.20).

Subgroup analyses indicated alpha blocker use was significantly associated with decreased risk for all-cause mortality in older patients (HR = 0.71; 95% CI, 0.51-0.99), women (HR = 0.68; 95% CI, 0.48-0.95), and those with CVD history (HR = 0.67; 95% CI, 0.48-0.95) or pre-dialysis blood pressure greater than or equal to 140 mm Hg (HR = 0.69; 95% CI, 0.49-0.98).

“We could not fully explain why this favorable effect was found only in specific hemodialysis populations, but not in total populations,” the researchers wrote. “However, recent studies have shown that alpha blockers may prevent cardiac remodeling and the development and progression of heart failure and have protective benefits against hyperinflammation and cytokine storm syndrome.”

Limitations of the study included its observational nature and many unaccounted-for confounders, such as muscle strength, physical activity and previous history of falls. There were also no data on the severity of falls, causes of the falls or whether the falls resulted in loss of consciousness, the authors wrote.

The findings “merit further investigation of their external validity” and further research is needed to “investigate if and how alpha blockers may produce favorable outcomes” in subgroups of patients on dialysis, the researchers wrote.