Response to Sympathetic Activity and Clinical Outcome in Dialysis Patients
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.