Evidence map›Paper›PMID 19273737›Full record

SynthesisHypertension (Dallas, Tex. : 1979)2009

Cardiovascular protection with antihypertensive drugs in dialysis patients: systematic review and meta-analysis.

Rajiv Agarwal, Arjun D Sinha

Registry-linked trialOpen access · greenAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Hypertension (Dallas, Tex. : 1979), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03594825 (Effect of Nighttime Valsartan on Prognosis of Nocturnal Hypertension Patients Undergoing Maintenance Hemodialysis), which is not on this map. Cited by 74 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
74citing papers in PubMed, 6 pooled it
11.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03594825 phase4unknown statusnot on this mapstarted 2018, after this paper: background citation

Effect of Nighttime Valsartan on Prognosis of Nocturnal Hypertension Patients Undergoing Maintenance Hemodialysis

TypeinterventionalSponsorFifth Affiliated Hospital, Sun Yat-Sen UniversityRan2018 to 2023Enrolled68ConditionsHypertension, NephropathyArmsValsartan
3 · Its place in the literature

Who cites it

74 citing papers in PubMed, 6 syntheses or guidelines pooled it, 209 citations in OpenAlex.

  1. Guideline
  2. Guideline
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Guideline
  7. Trial
  8. Trial
  9. Effects of frequent hemodialysis on blood pressure: Results from the randomized frequent hemodialysis network trials.Hemodialysis international. International Symposium on Home Hemodialysis · 2015
    Trial
  10. Hypertension in hemodialysis patients treated with atenolol or lisinopril: a randomized controlled trial.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2014
    Trial
  11. Design of the Blood Pressure Goals in Dialysis pilot study.The American journal of the medical sciences · 2014
    Trial
  12. Trial
  13. Article
  14. Article
  15. Review
  16. Article
  17. Article
  18. Review
  19. Review
  20. Article

14 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

2 authors at 1 institution in 1 country.

Rajiv AgarwalDivision of Nephrology, Department of Medicine, Indiana University School of Medicine, Richard L. Roudebush Veterans' Affairs Medical Center, Indianapolis, IN 46202, USA. ragarwal@iupui.edu
Arjun D Sinha
Richard L. Roudebush VA Medical Center · US

Funding

Hypertension in Hemodialysis PatientsR01DK062030 · NIDDK · INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS · PI AGARWAL, RAJIV · 2003 to 2013
$3.8M
NIDDK NIH HHS 5R01-DK062030-05NIDDK NIH HHS R01 DK062030
6 · The paper itself

Abstract

Epidemiological studies demonstrate that a lower blood pressure and decline in blood pressure over months or years are associated with higher mortality in dialysis patients. In contrast, randomized, controlled trials lack power to establish benefits of antihypertensive therapy. Patients on long-term dialysis participating in randomized, controlled trials and receiving antihypertensive drug therapy were the subject of this meta-analysis. Outcomes assessed were the hazard ratio of cardiovascular events and all-cause mortality in treated group compared with controls. Among 1202 patients who we identified in 5 studies, the overall benefit of antihypertensive therapy compared with the control or placebo group had a combined hazard ratio for cardiovascular events of 0.69 (95% CI: 0.56 to 0.84) using a fixed-effects model and 0.62 (95% CI: 0.45 to 0.86) using a random-effects model. In a sensitivity analysis, we found that the hypertensive group had a pooled hazard ratio of 0.49 (95% CI: 0.35 to 0.67), but when normotensives were included in the trial, lesser cardiovascular protection was seen (pooled hazard ratio of 0.86 [95% CI: 0.67 to 1.12]). Test for heterogeneity between hypertensive and "normotensive-included" groups was significant (P<0.006). Similar results were seen for risk ratio for death and cardiovascular events. There was evidence of publication bias based on Egger's test and funnel plot. Randomized trials suggested a benefit of antihypertensive therapy among hemodialysis patients. Adequately powered randomized trials are required to confirm these observations, especially among those with hypertension.

Indexed as

Renal DialysisAntihypertensive AgentsBlood PressureCardiovascular DiseasesHumansRandomized Controlled Trials as TopicAntihypertensive Agents

Identifiers

PMID19273737
PMCPMC2728674
OpenAlexW2037561970

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.