title: Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on left ventricular mass index and ejection fraction in hemodialysis patients: A meta-analysis with trial sequential analysis of randomized controlled trials.
abstract: BACKGROUND
  Angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) are effective therapies for left ventricular hypertrophy and heart failure. We aimed to assess the efficacy of ACEI and ARB in hemodialysis patients.
  
  
  METHODS
  The MEDLINE, EMBASE, and Cochrane Library databases were searched to identify studies published before December 2015 that investigated the use of ACEI or ARB compared with controls to determine the effect on the left ventricular mass index (LVMI) and ejection fraction (EF) in hemodialysis patients, and trial sequential analysis was also performed for outcomes.
  
  
  RESULTS
  A total of 357 cases of patients involved in 8 clinical trials (nine comparisons) were included. Compared with controls, ACEI/ARB treatment resulted in more effective improvement of LVMI in hemodialysis patients (weighted mean difference (WMD) -14.42, 95% confidence interval (CI) -20.89 to -7.95), and the cumulative z curve crossed the trial sequential monitoring boundary for benefit in trial sequential analysis. Although ACEI/ARB and controls did not show significant differences with regards to EF (WMD: -0.84, 95% CI: -2.91 to 1.24).
  
  
  CONCLUSIONS
  The comparison between ACEI/ARB and controls showed that the former type of drug causes a greater reduction in LVMI with hemodialysis patients, although they have no significant impact on the EF. Compared with other antihypertensive drugs or placebo, ACEI/ARB is recommended as a better choice in hemodialysis patients.
authors.affiliation: Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, PR China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Nephrology, State Discipline and State Key Laboratory of Kidney Disease (Chinese PLA General Hospital), Beijing 100853, PR China.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Nephrology, Beijing Tsinghua Changgeng Hospital, Beijing 102218, PR China.
authors.forename: Min-Xia
authors.initials: MX
authors.lastname: Li
authors.affiliation: Dialysis Center, Civil Aviation General Hospital, Beijing 100123, PR China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Xing
authors.affiliation: Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, PR China. Electronic address: wenge_lee2002@126.com.
authors.forename: Wen-Ge
authors.initials: WG
authors.lastname: Li
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy* / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D006435:Renal Dialysis / Q000639:trends; D013318:Stroke Volume / Q000187:drug effects* / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Angiotensin receptor blockers; Angiotensin-converting enzyme inhibitors; Ejection fraction; Hemodialysis; Left ventricular mass; Meta-analysis