Pressor Effect of Recombinant Human Erythropoietin: Results of Ambulatory Blood Pressure Monitoring and Home Blood Pressure Measurements

Abstract

We investigated whether treatment of anemic hemodialysis patients with a low dose of recombinant human erythropoietin (erythropoietin) for a short period would increase their blood pressure. Ambulatory blood pressure monitoring and home blood pressure measurements were used to detect minute increase in blood pressure. Thirty-two patients with a hematocrit of 25% or less received erythropoietin at the dose of 4500 IU/week, by the intravenous route for 8 weeks. Erythropoietin increased the hematocrit from 20.9 +/- 2.1 to 26.2 +/- 2.1%. Erythropoietin elevated mean ambulatory blood pressure by 5 mmHg or more in two-thirds of patients (n = 20; pressor group), while it elevated home mean blood pressure by 5 mmHg or more in one-third of patients (n = 11). An increase in clinic mean blood pressure by more than 5 mmHg was observed only in one-fourth of patients (n = 7). Circadian variation of blood pressure (nocturnal fall and diurnal rise) had been attenuated in the patients of the pressor group before erythropoietin treatment and erythropoietin decreased the nocturnal fall of blood pressure further more. Erythropoietin elevated nocturnal blood pressure more than diurnal blood pressure. Therefore, the increase in blood pressure induced by erythropoietin was detected more reliably by ambulatory blood pressure monitoring. There was no relation between the change in hemoglobin concentration and the increase in ambulatory blood pressure induced by erythropoietin. Erythropoietin tended to decrease cardiac output and plasma volume while it increased total peripheral resistance. It also decreased plasma norepinephrine and vasopressin levels but did not affect other humoral factors. Although the pressor effect of erythropoietin treatment for 8 weeks at the dose of 4500 IU/week was not evident on clinic blood pressure measurements, any increase in blood pressure determined by ambulatory blood pressure should be treated carefully to reduce the risk of a cardiovascular complication in patients receiving hemodialysis.

A Dosing Algorithm for Erythropoietin Alpha in Older Adults with Heart Failure and a Preserved Ejection Fraction

“…One unifying factor has been a lack of a significant reduction in cardiac output in patients in whom BP increases, which may be due to abnormal cardiovascular autoregulation in these patients. The lack of effect of epoetin alfa on BP in this trial is consistent with other reports [39], which found that with a dose of 4500 IU/week there was no observed pressor effect of epoetin alfa on clinic BP measurements, but demonstrable differences were detected by continuous ambulatory BP measurement. In this trial, we did not employ ambulatory BP measurements, and so cannot provide evidence for or against an ESA effect on continuous ambulatory BP measurements.…”

Guest Editor: Rajiv Agarwal: How Should Hypertension Be Assessed and Managed in Hemodialysis Patients?

“…For example, whereas routine BP monitoring failed to demonstrate changes in BP with the administration of erythropoietin (22), ABPM was able to detect a rise in overall BP with just 13 patients (23). ABPM was also more sensitive in detecting a rise in BP with erythropoietin than was home BP monitoring (24). We have exploited the reproducibility and sensitivity of ABPM in detecting antihypertensive effects of water‐soluble antihypertensive drugs administered to hemodialysis patients three times weekly using only a small number of subjects (25,26).…”

Editorials: Assessment of Blood Pressure in Hemodialysis Patients

“…For example, whereas routine BP monitoring failed to demonstrate changes in BP with the administration of erythropoietin (44), ABPM was able to detect an increase in overall BP with just 13 patients (45). When ABPM was compared to home BP monitoring, again ABPM was found to be more sensitive in detecting an increase in BP with erythropoietin (46). We have exploited the reproducibility and sensitivity of ABPM in detecting the effects of antihypertensive drugs administered to hemodialysis patients three times a week using only a small number of subjects (47,48).…”