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2017 ; 2
(4
): 665-675
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The Combination of Beta Blockers and Renin-Angiotensin System Blockers Improves
Survival in Incident Hemodialysis Patients: A Propensity-Matched Study
#MMPMID29142984
Luño J
; Varas J
; Ramos R
; Merello I
; Aljama P
; MartinMalo A
; Pascual J
; Praga M
Kidney Int Rep
2017[Jul]; 2
(4
): 665-675
PMID29142984
show ga
INTRODUCTION: Although several studies suggest that the prognosis of hypertensive
dialysis patients can be improved by using antihypertensive drug therapy, it is
unknown whether the prescription of a particular class or combination of
antihypertensive drugs is beneficial during hemodialysis. METHODS: We performed a
propensity score matching study to compare the effectiveness of various classes
of antihypertensive drugs on cardiovascular (CV) mortality in 2518 incident
hemodialysis patients in Spain. The patients had initially received
antihypertensive therapy with a renin-angiotensin system (RAS) blocker (728
patients), a ß-blocker (679 patients), antihypertensive drugs other than a RAS
blocker or a ß-blocker (787 patients), or the combination of a ß-blocker and a
RAS inhibitor (324 patients). These patients were followed for a maximum of 5
years (median: 2.21 yr; range: 1.04-3.34 yr). RESULTS: After adjustment for
baseline CV risk covariates, no significant differences were observed in the risk
of CV mortality between patients taking a RAS blocker and patients treated with
ß-blocker-based antihypertensive therapy. The combination of a RAS blocker with a
ß-blocker was associated with better CV survival than either agent alone (RAS
blocker: hazard ratio [HR]: 1.68; 95% confidence interval [CI] 1.05-2.69;
ß-blocker: HR: 1.59; 95% CI: 1.01-2.50; antihypertensive medication other than a
RAS blocker or ß-blocker: HR: 1.67; 95% CI: 1.08-2.58). DISCUSSION: Our data
suggested that the combination of a RAS blocker and a ß-blocker could improve
survival in hemodialysis patients. Further prospective randomized controlled
trials are necessary to confirm the beneficial effects of this combination of
antihypertensive drugs in patients undergoing hemodialysis.