Propranolol, Epinephrine, and Accelerated Hypertension During Hemodialysis

Excerpt

To the editor: Eighty percent of patients with severe renal insufficiency have hypertension before the institution of dialysis (1). Once on maintenance dialysis, approximately 25% will still require at least one antihypertensive medication (2). In certain instances, this dialysis-resistant hypertension is due to a relative or absolute increase in renin activity. Treatment has traditionally been with beta-blockers and more recently with angiotensin-converting enzyme inhibitors. As a group, the beta-blockers are the most commonly prescribed agents for control of hypertension, and they are usually well tolerated. The most dangerous adverse reactions are well known and include congestive heart failure, aggravation of