Lowering Blood Pressure Reduces Cardiovascular Risk in Dialysis Patients

In patients receiving dialysis, treatment to lower blood pressure reduces cardiovascular morbidity and mortality by about 30 percent, reports a systematic review and meta-analysis in The Lancet.

A comprehensive literature search was performed to identify randomized controlled trials of blood pressure–lowering therapy for patients on dialysis that included data on cardiovascular outcomes. Meta-analysis was performed using pooled data on 1679 patients from eight trials, including 495 cardiovascular events.

Patients receiving blood pressure lowering–therapy had a 4.5/2.3 mm Hg reduction in weighted mean blood pressure. Rates of cardiovascular events and cardiovascular death were significantly lower for treated patients: relative risk 0.71 for both outcomes. The protective effects of blood pressure lowering were similar for patients with and without hypertension and other comorbid conditions, and across different antihypertensive drug classes.

Patients on dialysis usually have high blood pressure, but the cardiovascular benefits of blood pressure reduction have been unclear. The new meta-analysis concludes that blood pressure lowering reduces the very high rates of cardiovascular events and cardiovascular death in this group of patients. Routinely considering treatment to reduce blood pressure might prevent a substantial number of deaths among patients undergoing dialysis, the authors suggest [Heerspink HJL, Ninomiya T, Zoungas S, de Zeeuw D, Grobbee DE, Jardine MJ, Gallagher M, Roberts MA, Cass A, Neal B, Perkovic V: Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials. Lancet 2009; 373:1009–1015].