Hypertension and Dialysis: A Comprehensive Systematic Review, Meta-Analysis, and Meta-Regression on Cardiovascular and Mortality Outcomes

Background: Hypertension is a major health condition that must be addressed in dialysis patients due to its influence on morbidity and mortality. This study aims to analyse and synthesise current research to systematically examine the impact of dialysis on patient outcomes and to investigate the role of different dialysis modalities. Methods: This systematic review and meta-analysis included 50 papers that explored the relationship between hypertension and dialysis outcomes, covering both randomised controlled trials and observational studies. A comprehensive search of PubMed, Embase, Scopus, and the Cochrane Library identified articles on blood pressure(BP) management, cardiovascular morbidity (CVM), and all-cause mortality in adult dialysis patients. A random effects model was employed to calculate pooled effect estimates, and meta-regression analysis was conducted to assess the influence of dialysis modality, duration, and comorbid conditions. Results: The meta- analysis demonstrated that poorly controlled hypertension (systolic BP> 140 mmHg) was associated with an increased risk of CVM (OR = 2. 45, 95% CI: 1. 90- 3. 16, p < 0. 001) and all- cause mortality (HR = 1. 78, 95% CI: 1. 50- 2. 13, p < 0. 001). No significant differences in hypertension-related outcomes were observed between haemodialysis (HD) and peritoneal dialysis (PD) according to meta-regression. A longer duration of dialysis (> 5 years) was linked to a higher risk of adverse outcomes (p = 0.03 for cardiovascular morbidity and p = 0.01 for mortality). Diabetes and obesity did not significantly influence the relationship between hypertension and patient outcomes. Conclusion: Hypertension remains a significant modifiable risk factor in dialysis patients, with poorly managed BP leading to adverse cardiovascular and mortality outcomes. The findings highlight the importance of early and intensive blood pressure management, regardless of the dialysis mode or co-morbidities. To improve long-term prognosis in this high-risk population, clinicians should focus on personalised treatment strategies, with an emphasis on consistent blood pressure control. Future research should aim to clarify blood pressure targets and explore targeted therapies for different patient population groups.