Case: HD patient with sys BP 180-200. no response to dry weight reduction (cant lower down, likely is at dry weight). On all classes of BP reduction meds (reasonable dose, ACEinh, BB, long acting CCB, vasodilator and central alpha agonist). Has tried lower HD Na bath with no help. Should ARB be added to the regimen?
In regards to BP management in general, do we know how much better BP control we get if we add Aceinh to ARB or vice versa? I understand we avoid this combination now because of recent concerns in CKD population.
Would anybody look at renal artery stenosis in dialysis patients (cases of resistant HTN with no other usual causes)?