Angiotensin Receptor Blocker Significantly Reducing Left Ventricular Mass Index, All-Cause and, Cardiovascular Mortality in Chronic Kidney Disease Patient with Hypertension Undergoing Maintenance Hemodialysis: A Network Meta-Analysis of Randomized Control Trial

Background: Cardiovascular diseases contribute to half of mortality in patients undergoing dialysis for kidney failure. Over 80% of dialysis patients are affected by hypertension, a leading risk factor for cardiovascular disease. However, the cardiovascular outcome of antihypertensives for patients on maintenance dialysis remains unclear. Objective: To assess the efficacy of antihypertensive drugs on cardiovascular outcomes in hypertensive patients undergoing maintenance dialysis. Method: We conducted a frequentist random-effects network meta-analysis of randomized, controlled trials that assessed the efficacy of antihypertensive agents in adult patients with hypertension undergoing maintenance dialysis. We searched PubMed, ScienceDirect, Wiley Online, CENTRAL, and Clinicaltrial.gov from the database up to November 2023 for relevant trials. The main outcome was a left ventricular mass index (LVMI) reduction. Result: Twenty-four trials (2386 participants) met our inclusion criteria. Angiotensin receptor blockers (ARB), mineralocorticoid receptor antagonists (MRA), ACE inhibitors, and calcium channel blockers reduced LVMI to a greater extent than placebo, although the result was not statistically significant. Subgroup analysis revealed that up to 6 months after treatment, ARB had a significant effect on reducing LVMI (MD -44.72, 95%CI -73.09 to -16.35). ARB (86.92%) was the top among all medical interventions, as determined by the SUCRA ranking. Additionally, ARB significantly decreased all-cause mortality (RR 0.45, 95%CI 0.29-0.70) and cardiovascular-related death (RR 0.56, 95%CI 0.36-0.88). Nevertheless, MRA also showed a substantial effect on all-cause mortality and cardiovascular-related death. Conclusion: ARB significantly reduced LVMI until 6 months after treatment and lowered the risk of all-cause and cardiovascular-related death in hypertensive patients undergoing maintenance hemodialysis.