- We recommend BP lowering medication to reduce all-cause and CV mortality in adult dialysis patients. (1B)
- We suggest β-blockers (βBs) as first line and calcium channel blockers (CCBs) as second line BP lowering medication in adults on haemodialysis, based upon BP lowering efficacy. (2B)
- We suggest ACE inhibitors (ACEi) as third line BP lowering medication in adults on haemodialysis, based upon BP lowering efficacy and enhanced risk of hypotension and discontinuation compared to βBs and CCBs. (2B)
- We suggest ACEis or angiotensin receptor blockers (ARBs) as first line BP lowering medication in people on peritoneal dialysis, based upon evidence that these classes of antihypertensive may slow loss of residual kidney function. (2B)
- We suggest mineralocorticoid receptor antagonists (MRAs), combined with careful monitoring of plasma potassium levels, may be considered in those with difficult to control BP. (2B)
- We suggest advising people on haemodialysis against the practice of omitting BP lowering medications prior to dialysis sessions. For those in whom BP lowering medication is implicated as contributing to IDH we suggest advising consistent evening dosing instead. (2D)
- We suggest that, where ꞵ-blockers are used, those with low dialysability are generally preferred in those receiving haemodialysis. (2C)
- We suggest that use of BP lowering medication with prolonged half-lives (e.g. atenolol, amlodipine, lisinopril or enalapril) in people on haemodialysis could be considered in those who are non-adherent to medication when combined with dosing at the end of the dialysis session. (2D)
- We suggest that L-carnitine and/or oral midodrine may be considered as part of a multi-faceted approach to management of IDH although data supporting usage is limited. (2C)
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