John Harnett, MB, BCh
In patients receiving maintenance dialysis, what is the effect of blood pressure (BP)–lowering treatments on cardiovascular (CV) outcomes?
Included studies evaluated treatments to lower BP in patients receiving dialysis and reported CV outcomes. Studies of children were excluded. Outcomes included all-cause mortality, CV mortality, and CV events (composite endpoint including myocardial infarction and CV mortality).
MEDLINE (1950 to Nov 2008), EMBASE/Excerpta Medica (1966 to Nov 2008), Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and reference lists were searched for randomized controlled trials (RCTs). 8 RCTs (n = 1679, mean age 61 y, 57% men) met the selection criteria and had a mean Jadad score of 3.1 out of 5; BP-lowering agents evaluated were angiotensin-receptor blockers (ARBs) (3 RCTs), angiotensin-converting enzyme inhibitors (2 RCTs), β-blockers (2 RCTs), and a calcium-channel blocker (1 RCT).
Meta-analysis showed that BP-lowering treatments reduced all-cause mortality, CV mortality, and CV events compared with placebo or usual treatment (Table).
Blood pressure–lowering treatments reduce cardiovascular outcomes in patients receiving maintenance dialysis.
Blood pressure (BP)–lowering treatment vs placebo or usual treatment (control) in patients receiving dialysis*
*CV = cardiovascular; other abbreviations defined in Glossary. Weighted event rates, RRR, NNT, and CI calculated from control event rates and relative risks in article using a random-effects model.
Harnett J. Review: Blood pressure–lowering treatments reduce CV morbidity and mortality in patients receiving dialysis. Ann Intern Med. ;151:JC1–6. doi: 10.7326/0003-4819-151-2-200907210-02006
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Published: Ann Intern Med. 2009;151(2):JC1-6.
Nephrology, Renal Replacement Therapy.
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