Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials.
Effect 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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DOI：
10.1016/s0140-6736(09)60212-9
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发表时间：
2009-03-21
期刊：
影响因子：
168.9
通讯作者：
Perkovic, Vlado
中科院分区：
文献类型：
--
作者：
Heerspink, HiddoJ Lambers;Ninomiya, Toshiharu;Zoungas, Sophia;de Zeeuw, Dick;Grobbee, Diederick E.;Jardine, Meg J.;Gallagher, Martin;Roberts, Matthew A.;Cass, Alan;Neal, Bruce;Perkovic, Vlado
接受透析的患者心血管死亡率和发病率的风险显著增加。虽然一些试验已经显示了降低血压在一般人群中的心血管益处，但在透析患者中降低血压的疗效和耐受性尚不确定。我们做了一个系统的回顾和荟萃分析，以评估透析患者血压降低的效果。我们系统地检索了Medline、Embase和科克伦图书馆数据库中1950年至2008年11月期间报道的试验，无语言限制。我们从报告心血管结局的透析患者血压降低的随机对照试验中提取了一个标准化数据集。采用随机效应模型进行Meta分析。我们确定了8项相关试验，这些试验提供了1679例患者和495例心血管事件的数据。与对照组相比，积极治疗患者的加权平均收缩压降低4.5 mm Hg，舒张压降低2.3 mm Hg。 与对照方案相比，降压治疗与心血管事件风险（RR 0.71，95% CI 0.55 - 0.92; p= 0.009）、全因死亡率（RR 0.80，0.66 - 0.96; p= 0.014）和心血管死亡率（RR 0.71，0.50 - 0.99; p= 0.044）降低相关。在研究中纳入的一系列患者组中，效果似乎是一致的。对于接受透析的个体，应常规考虑使用降低血压的药物治疗，以降低该人群中非常高的心血管发病率和死亡率。澳大利亚国家健康与医学研究理事会项目。
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. 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. 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. 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. National Health and Medical Research Council of Australia Program.