Impact of Angiotensin Receptor Blockers (ARB) versus Other Antihypertensive Medication on Blood Pressure in Patients on Dialysis: A Meta-Analysis

Abstract

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.

Keywords: Angiotensin receptor blocker; Antihypertensive agents; Diastolic blood pressure; Hemodialysis; Losartan; Post-dialysis; Systolic blood pressure.

Figure 1:

Preferred reporting items for systematic review and meta-analysis protocols (PRISMA) flow diagram of the study selection process.

Figure 2:

Effectiveness of ARB drugs on the systolic blood pressure (SBP) among the patients undergoing pre- and post-hemodialysis (n = 13). (a) Pre-hemodialysis, (b) Post-hemodialysis. CI: Confidence interval, ARB: Angiotensin receptor blocker, SD: standard deviation.

Figure 3:

Effectiveness of ARB drugs on the diastolic blood pressure (DBP) among the patients undergoing pre- and post-hemodialysis (n = 13). (a) Pre-hemodialysis, (b) Post-hemodialysis. CI: Confidence interval, ARB: Angiotensin receptor blocker, SD: standard deviation.

Figure 4:

Complications by angiotensin receptor blockers (ARB) agents among patients who underwent dialysis (n = 6). M-H: Mantel-Haenszel. CI: Confidence Interval.

Figure 5:

Subgroup analysis of the effectiveness of losartan (study group) and other ARB drugs (control group) on systolic blood pressure (SBP) among the patients undergoing hemodialysis. (a) Pre-dialysis, (b) Post-dialysis. CI: Confidence interval, ARB: Angiotensin receptor blocker, SD: standard deviation.

Figure 6:

Subgroup analysis of the effectiveness of losartan (study group) and other ARB drugs (control group) on diastolic blood pressure (DBP) among patients undergoing hemodialysis. (a) Pre-dialysis, (b) Post-dialysis. ARB: Angiotensin receptor blocker, CI: confidence interval, SD: standard deviation.