Key result
The provided supplementary text details the methodology and quality assessment for a meta-analysis of 13 studies evaluating ARBs in dialysis patients, but does not report the primary quantitative efficacy results.
Why the study?
Hypertension drives mortality among dialysis patients, and ARBs offer similar efficacy to ACE inhibitors with a lower incidence of side effects.
Do Angiotensin-II receptor blockers (ARBs) reduce blood pressure more effectively than other antihypertensive medications in adult dialysis patients?
Meta-Analysis
Do Angiotensin-II receptor blockers (ARBs) reduce blood pressure more effectively than other antihypertensive medications in adult dialysis patients?
In adult dialysis patients, ARBs and other antihypertensive medications demonstrate similar efficacy in reducing pre- and post-dialysis blood pressure.
ARB comparable to ACEI for BP control in dialysis with fewer side effects; extends pooled evidence supporting renin-angiotensin blockade in this population.
Introduction: Hypertension is an important factor driving mortality among dialysis patients. Angiotensin-II receptor blocker (ARB) has been effective similarly to angiotensin-converting enzymes (ACEs) but with a low incidence of side effects. Methodology: The meta-analysis included all published studies that investigated the effect of ARB on the hypertension in adult dialysis patients (≥18 years). Data extraction was guided by a predetermined checklist. Data sources of the retrieved studies were PubMed, MEDLINE, ScienceDirect, SCOPUS, Cochrane, Web of knowledge, and Google Scholar were systematically searched until February 2023. Using the RevMan 5 software, the mean difference for systolic and diastolic BP (SBP and DBP) and the risk ratio (RR) of the adverse events (AEs) were pooled from the selected studies. The random-effects model was used to compare the difference in the pre-and post-dialysis of the SBP and DBP. Data analyses were performed from December 2022 to February 2023. The primary outcome was the reduction in SBP and DBP in dialysis hypertensive patients who were on anti-hypertensive agents, and the secondary outcome was assessment of AE associated with the drug after dialysis (PROSPERO Registration: CRD42022355369). Results: The initial search yielded 1,679 records, of which 84 studies underwent full-text evaluation, which identified 13 studies and 1,462 patients. The pooled standard MD for losartan with other anti-hypertensive agents, where the pre-dialysis SBP was 0.17 (95% confidence interval [CI]: -0.21-0.55) and the post-dialysis was 0.35 (95% CI: -0.17-1.02); yet, both are statistically non-significant, implies that there was no difference between Losartan and ARB drugs regarding the effect on the SBP. Diastolic BP for predialysis was -0.01 (95% CI: -0.65-0.63) and post-dialysis was 0.03 (95% CI: -0.24-0.30) and statistically non-significant. AEs by the ARB agents were lower compared to other anti-antihypertensive agents (relative risk [RR]: 1.01; 95% CI: 0.59-1.75) and statistically non-significant. Conclusion: This systematic review and meta-analysis of RCT demonstrated that ARB and other anti-hypertensive medications had similar impacts on the treatment of hypertension.
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D.S. et al. (2024) conducted a meta-analysis in Hypertension in patients on dialysis. Angiotensin Receptor Blockers (ARB) vs. Other antihypertensive agents (calcium channel blockers, alpha and beta blockers, diuretics) or placebo was evaluated on Blood pressure (Systolic and Diastolic). The provided supplementary text details the methodology and quality assessment for a meta-analysis of 13 studies evaluating ARBs in dialysis patients, but does not report the primary quantitative efficacy results.
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