Background: Orthostatic hypotension (OH) is prevalent among dialysis patients and is a known cardiovascular (CV) risk factor. Beta-blockers (BBs) are commonly prescribed to mitigate CV mortality in this population despite potential risks associated with OH. This study examines the impact of BBs on CV mortality among dialysis patients with OH. Methods: We conducted a prospective analysis of 134 dialysis patients from the PRECADIA program at the Centro de Educacion Medica e Investigaciones Clinicas (CEMIC) focusing on hemodynamic assessments including blood pressure changes from supine to standing positions and evaluating CV mortality over a 3-year follow-up. OH was defined by a decrease of 10 mmHg or more in diastolic blood pressure or 20 mmHg or more in systolic blood pressure upon standing. Cox regression analyses were utilized to identify independent predictors of CV mortality. Results: Of the patients, 23.1% were identified with OH. No significant differences in demographic or baseline clinical characteristics were observed between patients with and without OH, except for a higher diabetes prevalence in the OH group. OH patients treated with BBs demonstrated significantly higher CV mortality (29.6%) compared to those not receiving BBs. Independent predictors of CV mortality included age, time on dialysis, and BB use, with BBs significantly associated with increased CV mortality risk. Conclusions: Dialysis patients with OH exhibit a high CV mortality rate significantly influenced by BB usage. While BBs are recommended for managing CV risks in dialysis patients, their association with increased CV mortality in patients with OH necessitates careful consideration and management strategies.

The authors have declared no competing interest.

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics Committee of Centro de Educacion Medica e Investigaciones Clinicas (CEMIC) gave ethical approval for this work

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present work are contained in the manuscript