How should antihypertensive medications be managed on dialysis days?

• A. They should be given as usual.
• B. They may be held or adjusted to avoid excessive intradialytic hypotension; follow physician orders.
• C. They should be stopped permanently.
• D. They should be doubled.

Answer: (B)

On dialysis days, blood pressure can drop during the procedure due to fluid removal, so antihypertensive medications are often held or their dose or timing adjusted to prevent excessive intradialytic hypotension. The safest approach is to follow the physician’s orders, tailoring the plan to each patient’s needs and dialysis schedule. Giving the meds as usual or doubling the dose can increase the risk of dangerous low BP during dialysis, while stopping them permanently isn’t appropriate unless the clinician specifies it. Some meds may be given after dialysis or have dose reductions on dialysis days to maintain overall blood pressure control without causing hypotension.