平均血圧降下度 収縮期 4.5 mmHg, 拡張期 2.3mmHg
心血管イベント (RR 0·71, 95% CI 0·55—0·92; p=0·009)
全死亡 (RR 0·80, 0·66—0·96; p=0·014)
心血管関連死亡 (RR 0·71, 0·50—0·99; p=0·044)
Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials ． The Lancet, Volume 373, Issue 9668, Pages 1009 - 1015, 21 March 2009
Editors' note: The number of people receiving dialysis is high and increasing. Such patients are at higher risk of cardiovascular disease and death than the general population. The renal system is important in regulating blood pressure so patients needing dialysis present a target population for blood pressure control. The few studies looking at blood pressure in dialysis patients have come up with diverse results which has not made generalisation easy. This meta-analysis clearly shows that control of blood pressure in dialysis patients is effective in reducing cardiovascular disease and mortality and the authors suggest that a simple, cheap, and effective treatment of BP should be seriously considered for all dialysis patients.
Hiddo J Lambers Heerspink PharmD a b, Toshiharu Ninomiya MD a, Sophia Zoungas MD a d, Prof Dick de Zeeuw MD b, Prof Diederick E Grobbee MD a c, Meg J Jardine MD a, Martin Gallagher MD a, Matthew A Roberts MD e f, Prof Alan Cass MD a, Prof Bruce Neal MD a, Dr Vlado Perkovic MD a
Patients undergoing dialysis have a substantially increased risk of cardiovascular mortality and morbidity. Although several trials have shown the cardiovascular benefits of lowering blood pressure in the general population, there is uncertainty about the efficacy and tolerability of reducing blood pressure in patients on dialysis. We did a systematic review and meta-analysis to assess the effect of blood pressure lowering in patients on dialysis.
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. Meta-analysis was done with a random effects model.
We identified 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 effects seem to be consistent across a range of patient groups included in the studies.
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.
National Health and Medical Research Council of Australia Program.