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Titolo	Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials
Autore	Hiddo J Lambers Heerspink, Toshiharu Ninomiya, Sophia Zoungas, Dick de Zeeuw, Diederick E Grobbee, Meg J Jardine, Martin Gallagher, Matthew A Roberts, Alan Cass, Bruce Neal, Vlado Perkovic
Referenza	The Lancet 2009; doi 10.1016-S0140-6736 (09) 60212-9
Contenuto	Background Patients undergoing dialysis have a substantially increased risk of cardiovascular mortality and morbidity. Although several trials have shown the cardiovascular benefi ts of lowering blood pressure in the general population, there is uncertainty about the effi cacy and tolerability of reducing blood pressure in patients on dialysis. We did a systematic review and meta-analysis to assess the eff ect of blood pressure lowering in patients on dialysis. Methods We systematically searched Medline, Embase, and the Cochrane Library database for trials reported between 1950 and November, 2008, without language restriction. We extracted a standardised dataset from randomised controlled trials of blood pressure lowering in patients on dialysis that reported cardiovascular outcomes. Metaanalysis was done with a random eff ects model. Findings We identifi ed eight relevant trials, which provided data for 1679 patients and 495 cardiovascular events. Weighted mean systolic blood pressure was 4·5 mm Hg lower and diastolic blood pressure 2·3 mm Hg lower in actively treated patients than in controls. Blood pressure lowering treatment was associated with lower risks of cardiovascular events (RR 0·71, 95% CI 0·55-0·92; p=0·009), all-cause mortality (RR 0·80, 0·66-0·96; p=0·014), and cardiovascular mortality (RR 0·71, 0·50-0·99; p=0·044) than control regimens. The eff ects seem to be consistent across a range of patient groups included in the studies. Interpretation 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.
Data	13.03.2009

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