Antihypertensive treatment is an essential, life-prolonging measure in
primary hypertension. It prevents
apoplexy,
myocardial infarction, and hypertensive
kidney failure.
Chronic kidney failure is associated with
hypertension and an accelerated form of
arteriosclerosis. Demise from cardiovascular affliction is a leading cause of death in renal patients (
chronic renal failure stages II-IV,
renal failure requiring
dialysis, renal transplantation). What, then, is the role of
antihypertensive treatment in such patients, and, specifically, what is achieved by
renin-
angiotensin-
aldosterone (RAA) system modifying agents? Two meta-analyses have recently investigated these issues. An article in The Lancet evaluated eight studies on dialysis patients (n = 1679). It concluded that
antihypertensives are beneficial in reducing cardiovascular morbidity and mortality. However, we criticize these conclusions and show that the data are not convincingly in favor of
antihypertensive treatment. A meta-analysis in the American Heart Journal assessed the role of
antihypertensive agents and RAA system modifying drugs in 45,758 patients (from 25 studies), who were in stages I-III of
renal failure, i.e., not (yet) requiring dialysis. The authors claim that
angiotensin- -converting enzyme inhibitors/
angiotensin receptor blockers (ACEI/ARB) significantly reduced cardiovascular outcomes. However, our analysis of the data is not consistent with their conclusions. It showed that the results were quite mixed, that the authors may have overemphasized the positive results, and that considering all the results, it should be concluded that
antihypertensive treatments, including those with ACEI/ARB, may not be superior to placebo (sic!) in renal patients. Rather than doing meta-analyses, larger primary studies are needed to reveal the real role of
antihypertensive treatments in renal patients.