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(Hypertension. 2009;54:e7.)
© 2009 American Heart Association, Inc.

Letters to the Editor

Response to Meta-Analysis of the Effects of Treating Blood Pressure on Cardiovascular Outcomes of Dialysis Patients

Indiana University School of Medicine, Indianapolis, Ind, Richard L. Roudebush Veterans’ Affairs Medical Center, Indianapolis, Ind

Arjun D. Sinha

Indiana University School of Medicine, Indianapolis, Ind

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Goldsmith and Covic¹ rightly conclude that it is premature to attribute cardiovascular benefits of antihypertensive drug use in hemodialysis patients to blood pressure (BP) lowering alone. Our meta-analysis points out the sharp difference between cohort studies and randomized trials; the former show harm with spontaneous fall in BP, whereas the latter show a benefit with antihypertensive drug use.² Heerspink et al,³ in their meta-analysis concluded, "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." However, given the problems with the current randomized trials and the heterogeneity in results, we concluded that, "adequately powered randomized trials are required to confirm these observations, especially among those with hypertension." Our meta-analysis should not be taken as "proof" that BP should be lowered in hemodialysis patients. Indeed, our conclusions are consistent with the urgent call by Goldsmith and Covic¹ for well-designed, randomized trials in this vulnerable population.

We had 3 fewer studies in our meta-analysis compared to the 1 by Heerspink et al.³ Two of the 3 studies in the meta-analysis of Heerspink et al³ were published in abstract form. The third study was done in peritoneal dialysis patients to test the notion of whether angiotensin-converting enzyme inhibitors protect the decline in residual renal function; this study was substantially different from other studies in hemodialysis patients, which were designed to study cardiovascular protection.⁴ Accordingly, we feel that the results of our meta-analysis accurately reflect the . . . [Full Text of this Article]