Effects of Blood Pressure Lowering Agents on All-Cause Mortality and Cardiovascular Events in Dialysis Patients: a Systematic Review and Network Meta-Analysis
| Autor: | Chang-Hsu Chen, 陳昶旭 |
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| Rok vydání: | 2019 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 107 Objective To assess the effects of different classes of antihypertensive agents on all-cause mortality and cardiovascular outcome in patients under dialysis. Design Systematic review and network meta-analysis of randomized controlled trials and observational studies within frequentist framework. Data sources Electronic literature search of PubMed, Web of Science and Cochrane library for published studies up to September 30, 2018. Study selection Randomized controlled trials (RCTs) and observational studies of anti-hypertension treatments, including but not limited to angiotensin receptor blocker (ARB), calcium channel blocker (CCB), mineralocorticoid receptor antagonist (MRA), in adult dialysis patients with a follow-up of at least 6 months, reporting all-cause mortality, cardiovascular (CV) mortality and CV events. Data extraction Information and patients’ characteristics of each study were extracted, including number of events for each outcome. Pooled estimates were presented as odds ratios (OR) and 95% confidence interval (CI) for dichotomous outcomes of each comparisons between two treatments. Results Total 19 RCTs and 5 observational studies with 59327 participants were identified, including 7704 all-cause mortality, 3745 CV mortality and 4746 CV events. MRA and ARB significantly reduced the risk of all-cause mortality compared to placebo (OR for MRA= 0.48, 95% CI 0.23-1.00; OR for ARB=0.61, 0.39-0.95). MRA was ranked first according to the highest value of estimated surface under the cumulative ranking curve. Contrast to MRA and ARB, β-blocker was most protective (OR= 0.23, 0.11-0.48) and ranked best in terms of CV mortality. We also found dual therapy (ACEI+ARB) harmful and ranked the worst treatment choice for each outcome (OR for all-cause mortality= 2.73, 1.29-5.75; OR for CV mortality= 3.46, 1.83-6.59), but most evidence was obtained from observational studies. Conclusion By applying NMA, MRA and ARB significantly reduced the risks of CV and all-cause mortality compared to placebo in dialysis patients. Contrast to MRA, which was ranked first to prevent all-cause mortality, β-blocker was more protective and ranked higher in terms of CV mortality. We also showed the harmful effects of ACEI+ARB on each outcome. |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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