Cardiovascular Effects of Angiotensin Converting Enzyme Inhibition or Angiotensin Receptor Blockade in Hemodialysis
- 1 April 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Journal of the American Society of Nephrology
- Vol. 5 (4), 623-630
- https://doi.org/10.2215/cjn.07831109
Abstract
Background and objectives: Cardiovascular (CV) disease causes significant morbidity and mortality among the hemodialysis (HD) population. This meta-analysis was performed to determine whether angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) reduce fatal and nonfatal CV events and left ventricular (LV) mass in patients receiving HD. Design, setting, participants, & measurements: Studies were identified by searching electronic databases, bibliographies, and conference proceedings. Two reviewers independently selected randomized controlled trials using ACEIs or ARBs compared with control among patients receiving HD. Studies were independently assessed for inclusion, quality, and data extraction. Random-effects models were used to estimate the pooled relative risk (RR) for CV outcomes and the weighted mean difference (WMD) for pooled change-from-baseline comparisons for LV mass for ACEI or ARB treated patients compared with control. Results: Compared with control, the RR of CV events associated with ACEI or ARB use was 0.66 [95% confidence interval (CI) 0.35 to 1.25; P = 0.20]. ACEI or ARB use resulted in a statistically significant reduction in LV mass, with a WMD of 15.4 g/m2 (95% CI 7.4 to 23.3; P < 0.001). Conclusions: Treatment with an ACEI or ARB reduced LV mass in patients receiving HD. However, their use was not associated with a statistically significant reduction in the risk of fatal and nonfatal CV events. Larger, high-quality trials in the HD population are required to determine if the effects of ACEI or ARB therapy on LV mass translate into decreased CV morbidity and mortality.Keywords
This publication has 43 references indexed in Scilit:
- Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trialsThe Lancet, 2009
- Preventing Left Ventricular Hypertrophy by ACE Inhibition in Hypertensive Patients With Type 2 DiabetesDiabetes Care, 2008
- Executive Summary: Kidney Early Evaluation Program (KEEP) 2007 Annual Data ReportAmerican Journal of Kidney Diseases, 2008
- United States Renal Data System 2007 Annual Data Report AbstractAmerican Journal of Kidney Diseases, 2008
- Effect of Frequent Nocturnal Hemodialysis vs Conventional Hemodialysis on Left Ventricular Mass and Quality of LifeJAMA, 2007
- Effect of Ramipril on Left Ventricular Mass in Normotensive Hemodialysis PatientsAmerican Journal of Kidney Diseases, 2006
- Effects of Imidapril on Left Ventricular Mass in Chronic Hemodialysis PatientsHypertension Research, 2006
- Review Article. Angiotensin converting enzyme inhibition for cardiac hypertrophy in patients with end-stage renal disease: What is the evidence?Nephrology, 2004
- Outcome and risk factors for left ventricular disorders in chronic uraemiaNephrology Dialysis Transplantation, 1996
- Impact of left ventricular hypertrophy on survival in end-stage renal diseaseKidney International, 1989