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Drugs that lower BP reduce cardiovascular morbidity, mortality in patients undergoing dialysis, meta-analysis finds
Tuesday, March 17 2009 | Comments
What's This?
Blood pressure (BP)-lowering agents should be standard therapy for patients who are undergoing dialysis, a group of Australian and Dutch researchers suggest.Since there has been uncertainty about the usefulness and tolerability of reducing BP in this patient population, the investigators conducted a systematic review and meta-analysis to clarify the issue. They found 8 randomized controlled trials from 1950 to November 2008 that evaluated BP-lowering agents and recorded cardiovascular outcomes among patients on dialysis.
In total, 1,679 enrollees on dialysis with or without hypertension were followed for a range of 12 to 36 months. The assessed drugs included angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors, beta blockers, and a calcium-channel blocker.
On average, the weighted difference between treated and control patients during follow-up was -4.5 mm Hg for systolic BP and -2.3 mm Hg for diastolic BP.
Additional results showed that the risk of cardiovascular events was 29% lower with BP-lowering drugs than with control regimens (risk ratio [RR], 0.71; 95% CI, 0.55-0.92; P=.009). There were also reduced risks for all-cause mortality (RR, 0.80; 95% CI, 0.66-0.96; P=.014) and for cardiovascular mortality (RR, 0.71; 95% CI, 0.50-0.99; P=.044) among the treated patients relative to controls.
These results were consistent across comorbidities and drug classes, and the therapies appeared to be well-tolerated.
Thus, the study authors advised routine use of these treatments in patients undergoing dialysis to reduce their cardiovascular morbidity and mortality.
"If our data are applied to a broad population of patients on dialysis with an annual mortality rate of about 10%, we calculate that BP-lowering treatment could prevent 2 of the 10 deaths expected to occur in every 100 patients per year. This absolute benefit will be greater for individuals at high absolute risk, and is much greater than that reported for many other interventions in routine use," they concluded.
The complete study was published online, ahead of print, on Feb. 26 by Lambers Heerspink HJ, et al. in The Lancet.
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