Mechanisms and Treatment of Intradialytic Hypertension

Blood Pressure, Endothelial Cell Dysfunction, and Outcomes in Dialysis Patients

1. To determine in a cross sectional case-controlled cohort study of 50 hemodialysis patients if blood pressure elevations with hemodialysis are associated with decreased endothelial cell function (measured by brachial artery flow mediated dilation and endothelial progenitor cell number), both of which are novel mechanistic markers in the causal pathway for detrimental cardiovascular outcomes; and
2. To determine if lowering blood pressure with carvedilol in 25 ESRD subjects with blood pressure elevations with hemodialysis can improve endothelial cell dysfunction as a surrogate mechanistic marker for improving cardiovascular outcomes.

Inclusion Criteria:

• on hemodialysis > 30 days
• aged 18 to 80 years old
• ability to provide informed consent
• Primary nephrologist deems patient is at target dry weight
• Predialysis SBP >140 or postdialysis SBP>130

Exclusion Criteria:

• Patients with active wounds
• Blood pressure unable to be measured by routine mechanisms in the upper extremity
• Change in blood pressure medications in the previous 2 weeks
• Intolerance of beta or alpha-blockers
• pregnancy
• Resting heart rate <50
• Life expectancy < 6 months
• Current therapy with carvedilol or contraindication to carvedilol (ONLY in the intervention arm)