Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials.
BACKGROUND
Patients undergoing dialysis have a substantially increased risk of cardiovascular mortality and morbidity. Although several trials have shown the cardiovascular benefits of lowering blood pressure in the general population, there is uncertainty about the efficacy and tolerability of reducing blood pressure in patients on dialysis. We did a systematic review and meta-analysis to assess the effect of blood pressure lowering in patients on dialysis.


METHODS
We systematically searched Medline, Embase, and the Cochrane Library database for trials reported between 1950 and November, 2008, without language restriction. We extracted a standardised dataset from randomised controlled trials of blood pressure lowering in patients on dialysis that reported cardiovascular outcomes. Meta-analysis was done with a random effects model.


RESULTS
We identified eight relevant trials, which provided data for 1679 patients and 495 cardiovascular events. Weighted mean systolic blood pressure was 4.5 mm Hg lower and diastolic blood pressure 2.3 mm Hg lower in actively treated patients than in controls. Blood pressure lowering treatment was associated with lower risks of cardiovascular events (RR 0.71, 95% CI 0.55-0.92; p=0.009), all-cause mortality (RR 0.80, 0.66-0.96; p=0.014), and cardiovascular mortality (RR 0.71, 0.50-0.99; p=0.044) than control regimens. The effects seem to be consistent across a range of patient groups included in the studies.


CONCLUSIONS
Treatment with agents that lower blood pressure should routinely be considered for individuals undergoing dialysis to reduce the very high cardiovascular morbidity and mortality rate in this population.
Heerspink
Hiddo J Lambers
HJ
George Institute for International Health, University of Sydney, Sydney, Australia.
Ninomiya
Toshiharu
T
Zoungas
Sophia
S
de Zeeuw
Dick
D
Grobbee
Diederick E
DE
Jardine
Meg J
MJ
Gallagher
Martin
M
Roberts
Matthew A
MA
Cass
Alan
A
Neal
Bruce
B
Perkovic
Vlado
V
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D015984:Causality; D015897:Comorbidity; D004039:Diet, Sodium-Restricted; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome
D000959:Antihypertensive Agents