Table 3 Summary of treatment of hypertension in dialysis patients

• Patient heterogeneity and lack of comparative evidence preclude the recommendation of one class of drug over another for all dialysis patients.

• Most ARBs are not dialyzed during conventional dialysis and can be used for sustained BP reduction. However, RCTs have failed to confirm the benefit of RASi in dialysis patients as in the general population.

• β-blockers may be used as the first-line therapy in dialysis patients because they can control the sympathetic overactivity and LVH which contribute to the high incidence of arrhythmias and sudden cardiac death.

• In a recent study, the use of mineralocorticoid receptor antagonists such as spironolactone showed promising results in reducing mortality by more than 50% in dialysis patients. However, safety issues such as hyperkalemia or hypotension should be further evaluated.

• Volume overload or nonadherence to medications are common causes of resistant hypertension in dialysis patients.