We recommend that blood pressure should be monitored in all people receiving ESAs and, if present, hypertension be treated by volume removal and/or hypotensive drugs. (1A)
Rationale
Hypertension is the most common complication in CKD and can be aggravated by ESA treatment (1). Earlier studies demonstrated higher incidence rates of hypertension though ESA doses used were higher and Hb responses faster in these trials. It is now more common to start at low doses and increase gradually according to response. The commonest cause of hypertension in CKD is not ESA therapy.
Exacerbation of hypertension in patient on ESA therapy may be associated with polycythaemia or rapidly rising haemoglobin levels. These complications should be looked for in patients with hypertension but in the absence of these complicating factors and in the absence of severe hypertension, ESA therapy can usually continue. Hypertension should be adequately controlled prior to initiating ESA therapy. ESA therapy should be discontinued in malignant hypertension.
References
- Horl WH, Jacobs C, Macdougall IC et al. European Best Practice Guidelines 14-16: inadequate response to epoetin. Nephrol Dial Transplant 2000; 15 Suppl 4: 43-50.