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(Hypertension. 2009;54:e9.)
© 2009 American Heart Association, Inc.

Letters to the Editor

Response to Sympathetic Activity and Clinical Outcome in Dialysis Patients

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

An extract of the first 100% of the full text is provided, because this article has no abstract.

Siddiqi and Blankestijn¹ suggest that inhibition of the renin-angiotensin system may provide an additional explanation for cardiovascular benefits among hemodialysis patients. Randomized trials currently available in hemodialysis patients do not provide data sufficient to demonstrate a robust effect of renin-angiotensin system inhibitors on cardiovascular mortality or morbidity beyond blood pressure lowering. Our meta-analysis discusses the potential benefits of antihypertensive drugs (eg, renin-angiotensin system inhibitors and β-blockers) beyond blood pressure lowering on cardiovascular events and calls for randomized trials in these vulnerable but understudied patients.² To this extent, we are currently conducting a randomized, controlled trial comparing an angiotensin-converting enzyme inhibitor with a β-blocker on the reduction in echocardiographic left ventricular hypertrophy in long-term hemodialysis patients with hypertension and left ventricular hypertrophy (http://www.clinicaltrials.gov identifier NCT00582114). Both groups have similar targeted blood pressures, so we should be able to provide some answers to the important questions that they pose in their letter.

Disclosures

None.

1. Siddiqi L, Blankestijn PJ. Sympathetic activity and clinical outcome in dialysis patients. Hypertension. 2009; 54: e8.[Free Full Text]

2. Agarwal R, Sinha AD. Cardiovascular protection with antihypertensive drugs in dialysis patients: systematic review and meta-analysis. Hypertension. 2009; 53: 860–866.[Abstract/Free Full Text]