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Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials

Lambers Heerspink, Hiddo J., Ninomiya, Toshiharu, Zoungas, Sophia, de Zeeuw, Dick, Grobbee, Diederick E., Jardine, Meg J., Gallagher, Martin, Roberts, Matthew A., Cass, Alan, Neal, Bruce and Perkovic, Valdo (2009). Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials. The Lancet,373(9668):1009-1015.

Document type: Journal Article

IRMA ID 84473293xPUB43
Title Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials
Author Lambers Heerspink, Hiddo J.
Ninomiya, Toshiharu
Zoungas, Sophia
de Zeeuw, Dick
Grobbee, Diederick E.
Jardine, Meg J.
Gallagher, Martin
Roberts, Matthew A.
Cass, Alan
Neal, Bruce
Perkovic, Valdo
Journal Name The Lancet
Publication Date 2009
Volume Number 373
Issue Number 9668
ISSN 0140-6736   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-62349103944
Start Page 1009
End Page 1015
Total Pages 6
Place of Publication United Kingdom
Publisher The Lancet Publishing Group
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
Patients undergoing dialysis have a substantially increased risk of cardiovascular mortality and morbidity. Although several trials have shown the cardiovascular benefits of lowering blood pressure in the general population, there is uncertainty about the efficacy and tolerability of reducing blood pressure in patients on dialysis. We did a systematic review and meta-analysis to assess the effect of blood pressure lowering in patients on dialysis.

Methods
We systematically searched Medline, Embase, and the Cochrane Library database for trials reported between 1950 and November, 2008, without language restriction. We extracted a standardised dataset from randomised controlled trials of blood pressure lowering in patients on dialysis that reported cardiovascular outcomes. Meta-analysis was done with a random effects model.

Findings
We identified eight relevant trials, which provided data for 1679 patients and 495 cardiovascular events. Weighted mean systolic blood pressure was 4·5 mm Hg lower and diastolic blood pressure 2·3 mm Hg lower in actively treated patients than in controls. Blood pressure lowering treatment was associated with lower risks of cardiovascular events (RR 0·71, 95% CI 0·55–0·92; p=0·009), all-cause mortality (RR 0·80, 0·66–0·96; p=0·014), and cardiovascular mortality (RR 0·71, 0·50–0·99; p=0·044) than control regimens. The effects seem to be consistent across a range of patient groups included in the studies.

Interpretation
Treatment with agents that lower blood pressure should routinely be considered for individuals undergoing dialysis to reduce the very high cardiovascular morbidity and mortality rate in this population.
DOI http://dx.doi.org/10.1016/S0140-6736(09)60212-9   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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Created: Tue, 24 Feb 2015, 12:24:33 CST