title: A systematic review on randomized control trials on rennin angiotensin aldosterone system inhibitors role in managing hypertension among hemodialysis patients.
abstract: Randomized control trials (RCTs) are considered as most rigors way of determining the cause-effect relationship of a treatment and outcome. Activation of rennin angiotensin aldosterone system (RAAS) is an important contributor to hypertension in hemodialysis patients. The prevalence of hypertension in hemodialysis patients varies from 60% to 80% and hypertension management alone with conventional hemodialysis is insufficient. Hence, the current review was aimed to investigate the effect of RAAS inhibitors in managing hypertension among hemodialysis patients in a randomized control trial. Using PUBMED and EMBASE databases, randomized control trial with primary or secondary outcomes related to the effect of RAAS inhibitors on blood pressure among hemodialysis patients were included for analysis. The current review also assessed the quality of reporting of RCT. A total of eight RCT met inclusion criteria for current review. According to modified jaded scale, one (12.5%) study scored four points for quality reporting, whereas two (25%) studies scored one point that was the least score. The mean score for all included studies was 2.25. Six (75%) of the eight RCT included, involved ARB in hypertension management among hemodialysis patients, whereas two (25%) studies involved angiotensin-converting enzyme (ACE) inhibitors. Of the siz RCT involving ARB, two (33.3%) RCT also included ACE inhibitors comparison group. Altogether six (75%) studies report a reduction in blood pressure with the use of RAAS inhibitors compared to control group; however, of the six studies, two (33.3%) reported that the reduction in blood pressure was not significant. Whereas, two (25%) studies reported no reduction in blood pressure compared to the control group. The findings from current review do not indicate a clear pattern for a role of RAAS inhibitors for hypertension control among hemodialysis patients.
authors: a Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences , University Sains Malaysia , Penang , Malaysia ;|b Chronic Kidney Disease Resource Centre, School of Medical Sciences , Health Campus, University Sains Malaysia , KubangKerain , Kelantan , Malaysia.
authors: Raja Ahsan
authors: RA
authors: Aftab
authors: a Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences , University Sains Malaysia , Penang , Malaysia ;
authors: Amer Hayat
authors: AH
authors: Khan
authors: b Chronic Kidney Disease Resource Centre, School of Medical Sciences , Health Campus, University Sains Malaysia , KubangKerain , Kelantan , Malaysia.
authors: Azreen Syazril
authors: AS
authors: Adnan
authors: b Chronic Kidney Disease Resource Centre, School of Medical Sciences , Health Campus, University Sains Malaysia , KubangKerain , Kelantan , Malaysia.
authors: Nurul
authors: N
authors: Jannah
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000009:adverse effects*; D012084:Renin-Angiotensin System / Q000187:drug effects*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents
keywords: End stage renal disease; hemodialysis; hypertension; randomized control trials; rennin angiotensin aldosterone system