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Beta-blockade found to benefit ESRD patient survival and CV risk |
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ERA-EDTA: Rajiv Agarwal and colleagues report in the March issue of NDT the very first study to make a head-to-head comparison of a beta-blocker (atenolol) with an ACEi (lisinopril), the Hypertension in Haemodialysis Patients Treated with Atenolol or Lisinopril (HDPAL) study, a trial in which the primary endpoint was regression of LVH. This trial was recently presented at the 2013 ASN Congress in Atlanta. After a 12-month treatment period with atenolol or with lisinopril-based regimens, hypertensive patients achieved a similar fall in 44-h interdialysis ABPM (-21/-13 mmHg; -18/-10 mmHg, respectively). Nonetheless, the risk for hospitalizations for heart failure and cardiovascular events including myocardial infarction, stroke and cardiovascular death was markedly higher in the lisinopril than in the atenolol group. Overall, the incidence rate ratio for major cardiovascular events was more than double in the lisinopril than in the atenolol group, and the independent safety monitoring board recommended an early stop of the trial.
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