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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

Summary 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... Full description

Journal Title: Lancet 2009, Vol.373 (9668), p.1009-1015
Main Author: Heerspink, Hiddo J Lambers, PharmD
Other Authors: Ninomiya, Toshiharu, MD , Zoungas, Sophia, MD , de Zeeuw, Dick, Prof , Grobbee, Diederick E, Prof , Jardine, Meg J, MD , Gallagher, Martin, MD , Roberts, Matthew A, MD , Cass, Alan, Prof , Neal, Bruce, Prof , Perkovic, Vlado, Dr
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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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
format: Article
creator:
  • Heerspink, Hiddo J Lambers, PharmD
  • Ninomiya, Toshiharu, MD
  • Zoungas, Sophia, MD
  • de Zeeuw, Dick, Prof
  • Grobbee, Diederick E, Prof
  • Jardine, Meg J, MD
  • Gallagher, Martin, MD
  • Roberts, Matthew A, MD
  • Cass, Alan, Prof
  • Neal, Bruce, Prof
  • Perkovic, Vlado, Dr
subjects:
  • Abridged Index Medicus
  • Antihypertensive Agents - therapeutic use
  • Articles
  • Biological and medical sciences
  • Blood pressure
  • Cardiovascular disease
  • Cardiovascular diseases
  • Cardiovascular Diseases - epidemiology
  • Cardiovascular Diseases - prevention & control
  • Causality
  • CHRONIC KIDNEY-DISEASE
  • CLINICAL-TRIALS
  • Comorbidity
  • Control
  • Diet, Sodium-Restricted
  • Drug therapy
  • ENZYME-INHIBITOR
  • FOLIC-ACID
  • General aspects
  • Health aspects
  • Hemodialysis
  • HEMODIALYSIS-PATIENTS
  • Humans
  • Hypertension - epidemiology
  • Hypertension - etiology
  • Hypertension - therapy
  • Internal Medicine
  • Medical research
  • Medical sciences
  • Meta-analysis
  • Mortality
  • PREVENTION
  • PROSPECTIVELY-DESIGNED OVERVIEWS
  • QUALITY
  • RAMIPRIL
  • Renal Dialysis - adverse effects
  • Renal Dialysis - mortality
  • Risk factors
  • STAGE RENAL-DISEASE
  • Studies
  • Survival Rate
  • Systematic review
  • Treatment Outcome
  • UMCG Approved
ispartof: Lancet, 2009, Vol.373 (9668), p.1009-1015
description: Summary 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. Funding National Health and Medical Research Council of Australia Program.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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titleEffect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials
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creatorHeerspink, Hiddo J Lambers, PharmD ; Ninomiya, Toshiharu, MD ; Zoungas, Sophia, MD ; de Zeeuw, Dick, Prof ; Grobbee, Diederick E, Prof ; Jardine, Meg J, MD ; Gallagher, Martin, MD ; Roberts, Matthew A, MD ; Cass, Alan, Prof ; Neal, Bruce, Prof ; Perkovic, Vlado, Dr
creatorcontribHeerspink, Hiddo J Lambers, PharmD ; Ninomiya, Toshiharu, MD ; Zoungas, Sophia, MD ; de Zeeuw, Dick, Prof ; Grobbee, Diederick E, Prof ; Jardine, Meg J, MD ; Gallagher, Martin, MD ; Roberts, Matthew A, MD ; Cass, Alan, Prof ; Neal, Bruce, Prof ; Perkovic, Vlado, Dr
descriptionSummary 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. Funding National Health and Medical Research Council of Australia Program.
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publisherKidlington: Elsevier Ltd
subjectAbridged Index Medicus ; Antihypertensive Agents - therapeutic use ; Articles ; Biological and medical sciences ; Blood pressure ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - prevention & control ; Causality ; CHRONIC KIDNEY-DISEASE ; CLINICAL-TRIALS ; Comorbidity ; Control ; Diet, Sodium-Restricted ; Drug therapy ; ENZYME-INHIBITOR ; FOLIC-ACID ; General aspects ; Health aspects ; Hemodialysis ; HEMODIALYSIS-PATIENTS ; Humans ; Hypertension - epidemiology ; Hypertension - etiology ; Hypertension - therapy ; Internal Medicine ; Medical research ; Medical sciences ; Meta-analysis ; Mortality ; PREVENTION ; PROSPECTIVELY-DESIGNED OVERVIEWS ; QUALITY ; RAMIPRIL ; Renal Dialysis - adverse effects ; Renal Dialysis - mortality ; Risk factors ; STAGE RENAL-DISEASE ; Studies ; Survival Rate ; Systematic review ; Treatment Outcome ; UMCG Approved
ispartofLancet, 2009, Vol.373 (9668), p.1009-1015
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descriptionSummary 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. Funding National Health and Medical Research Council of Australia Program.
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titleEffect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials
authorHeerspink, Hiddo J Lambers, PharmD ; Ninomiya, Toshiharu, MD ; Zoungas, Sophia, MD ; de Zeeuw, Dick, Prof ; Grobbee, Diederick E, Prof ; Jardine, Meg J, MD ; Gallagher, Martin, MD ; Roberts, Matthew A, MD ; Cass, Alan, Prof ; Neal, Bruce, Prof ; Perkovic, Vlado, Dr
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atitleEffect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials
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abstractSummary 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. Funding National Health and Medical Research Council of Australia Program.
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