Blood pressure lowering for kidney transplant recipients: systematic review with network meta-analysis.

Abstract

OBJECTIVE:

Hypertension affects 50-90% of kidney transplant recipients and is associated with cardiovascular disease and graft loss. We aimed to evaluate the comparative benefits and harms of blood pressure lowering agents in people with a functioning kidney transplant.

METHODS:

We conducted a systematic review with network meta-analysis of randomized controlled trials (RCTs). We searched MEDLINE, Embase, and CENTRAL through to October 2023. RCTs evaluating blood pressure lowering agents administered for at least 2 weeks in people with a functioning kidney transplant with and without preexisting hypertension were eligible. Two reviewers independently extracted data. The primary outcome was graft loss. Treatment effects were estimated using random effects network meta-analysis, with treatment effects expressed as an odds ratio (OR) for binary outcomes and mean difference (MD) for continuous outcomes together with their 95% confidence interval (CI). Confidence in the evidence was assessed using GRADE for network meta-analysis.

RESULTS:

Ninety-four studies (7547 adults) were included. Two studies were conducted in children. No blood pressure-lowering agent reduced the risk of graft loss, withdrawal because of adverse events, death, cardiovascular or kidney outcomes compared with placebo/other drug class. Angiotensin-converting enzyme inhibitors and angiotensin receptor blocker therapy may incur greater odds of hyperkalemia compared with calcium channel blockers [odds ratio (OR) 5.48, 95% confidence interval (CI) 2.47-12.16; and OR 8.67, 95% CI 2.65-28.36; low certainty evidence, respectively).

CONCLUSION:

The evidentiary basis for the comparative benefits and safety of blood pressure lowering agents in people with a functioning kidney transplant is limited to guide treatment decision-making.

• Authors: Patrizia Natale, Suetonia C Palmer, Allison Jaure, Valeria Saglimbene, Andrea Iannone, Amanda Sluiter, Jonathan Craig, Giovanni F M Strippoli
• Journal: Journal of hypertension (J Hypertens) Vol. 42 Issue 5 Pg. 848-855 (May 01 2024) ISSN: 1473-5598 [Electronic] Netherlands
• PMID: 38230619 (Publication Type: Meta-Analysis, Systematic Review, Journal Article)
• Copyright: Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Angiotensin-Converting Enzyme Inhibitors

Topics

• Child
• Adult
• Humans
• Blood Pressure
• Kidney Transplantation (adverse effects)
• Network Meta-Analysis
• Hypertension (drug therapy)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)