Do Beta Blockers Help Prevent Heart Failure in Dialysis Patients?
Heart failure (HF) is more common and at least as lethal as ischemic coronary heart disease (CHD) in patients with severe chronic kidney disease, including those on long-term dialysis. HF also differs from CHD, and different therapy is needed. Preload reduction and blood pressure control aren’t enough: neurohormonal blockade with beta blockers and angiotensin-converting enzyme (ACE)-inhibitors is also essential, say researchers from Walter Reed Army Medical Center, the Uniformed Ser vices University of the Health Sciences, the Madigan Army Medical Center, the National Institutes of Health, and Rush-Presbyterian Medical Center. Given the overactivity of the sympathetic nervous system in renal parenchymal disease, they theorized, beta blockers ought to be the ideal antihypertensive agents for dialysis patients.
To test this theory, the researchers conducted a retrospective study of 2,550 patients enrolled in the U.S. Renal Data System. Among those patients, 20% with known HF were using beta blockers, as were 19% of those without known HF. generic aciphex
The use of beta blockers was independently associated with a lower risk of de novo HF, a composite outcome of HF and cardiovascular death, and all-cause death, even in models limited to patients taking beta blockers. Beta-blocker use remained statistically significant even when the researchers adjusted for diabetes, CHD, or hemo-dialysis or peritoneal dialysis.
The use of ACE-inhibitors was not associated with de novo HF, cardiovascular death, or all-cause death in dialysis patients who did not have known HF. Aspirin use increased the risk of recurrent HF, as did the use of beta blockers and aspirin together.
Although the use of cardioselective beta blockers was statistically significant, the use of noncardioselective beta block-ers, also used much less frequently, was not. (Cardioselective beta blockers are less prone to causing peripheral vaso-constriction and are associated with a lower risk of hyperkalemia than non-cardioselective beta blockers. This might partly explain why they were used more often.)
The study revealed a lack of benefit from beta blockers in patients with established HF, but the researchers suggest that it would be premature for clinicians to withhold beta blockers from patients with end-stage renal disease and a history of HF.
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As many as 70% of high-risk patients can tolerate beta blockers; thus, their use in dialysis patients seems far lower than is appropriate.
