Should all hypertensive dialysis patients receive a blocker of the Renin-Angiotensin system?
Cardiovascular mortality and hypertension remain common in the dialysis population, and two recent meta-analyses have suggested that antihypertensive pharmacotherapy reduces cardiovascular events in dialysis patients. Based on their benefits in other populations, blockers of the renin-angiotensin-aldosterone system (RAAS) are an attractive treatment option. The evidence that RAAS blockers improve surrogate end points is mixed. However, a recent meta-analysis found significant improvement in left ventricular mass with RAAS-blocking drugs in hemodialysis patients. Only a few trials have examined RAAS-blocking drugs and cardiovascular events in dialysis patients, and a recent meta-analysis found no significant benefit in hemodialysis patients. The single trial of peritoneal dialysis patients that reported cardiovascular events found no benefit from RAAS blockers. Fortunately, the risk of hyperkalemia appears low. Based on the available evidence, we cannot categorically recommend that all hypertensive dialysis patients be treated with RAAS blockers. We await the results of adequately powered clinical trials.
Sinha
Arjun D
AD
Veterans Affairs Medical Center, 111N, 1481 West 10th Street, Indianapolis, IN 46202, USA.
Agarwal
Rajiv
R
D054058:Acute Coronary Syndrome / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced / Q000517:prevention & control; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D012084:Renin-Angiotensin System / Q000187:drug effects*; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents
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