a-Blocker Use in Hemodialysis: The Japan Dialysis Outcomes and Practice Patterns Study

Rationale & Objective: Despite a-blockers' use for hypertension as add-on therapy in patients treated with hemodialysis, scant information is available on their association, particularly with safety, in these patients.Study Design: Prospective cohort study.Setting & Participants: patients treated with hemodialysis and receiving antihypertensive agents in the Japan Dialysis Outcomes and Practice Patterns Study, phases 4-6, were analyzed.Exposure: Primary exposure was the prescription of a-blocking antihypertensive agents at baseline.Outcomes: Incident fractures, falls, and all-cause mortality.Analytical Approach: Multivariable Cox and modified Poisson regression analysis.Results: Of 5,149 patients treated with hemodialysis (mean age, 65 years; 68% men) receiving antihypertensive drugs, 717 (14%) received a-blocking agents. During a mean follow-up period of 2.0 years, 247 fractures, 525 falls, and 498 deaths occurred. Multivariable analysis showed no significant association of a-blocker use and increased risk of fractures (hazard ratio [HR], 0.92 [95% confidence interval {CI}, 0.61-1.3 8]), falls (HR, 0.94 [95% CI, 0.74-1.20]), or all-cause deaths (HR, 0.87 [95% CI, 0.6 4-1.20]) compared with a-blocker nonuse. a-Blocker use was, however, significantly associated with a decreased risk of all-cause mortality in the subgroup analysis, for example, patients who were older (HR, 0.71 [95% CI, 0.51-0.9 9]), were women (HR, 0.68 [95% CI, 0.4 8-0.95]), or reported a history of cardiovascular disease (HR, 0.67 [95% CI, 0.4 8-0.95]) or a predialysis blood pressure of =140 mm Hg (HR, 0.69 [95% CI, 0.49-0.9 8]).Limitations: Selection bias cannot be ruled out given the prevalent user analysis. Conclusions: No significant association between a-blocker use and the risk of worse safety-related outcomes was seen, indicating that clinicians may safely prescribe a-blockers to patients receiving hemodialysis who require blood pressure lowering.