Background: Angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) are effective therapies for left ventricular hypertrophy and heart failure. We aimed to assess the efficacy of ACEI and ARB in hemodialysis patients. Methods: The MEDLINE, EMBASE, and Cochrane Library databases were searched to identify studies published before December 2015 that investigated the use of ACEI or ARB compared with controls to determine the effect on the left ventricular mass index (LVMI) and ejection fraction (EF) in hemodialysis patients, and trial sequential analysis was also performed for outcomes. Results: A total of 357 cases of patients involved in 8 clinical trials (nine comparisons) were included. Compared with controls, ACEI/ARB treatment resulted in more effective improvement of LVMI in hemodialysis patients (weighted mean difference (WMD) - 14.42, 95% confidence interval (CI) - 20.89 to - 7.95), and the cumulative z curve crossed the trial sequential monitoring boundary for benefit in trial sequential analysis. Although ACEI/ARB and controls did not show significant differences with regards to EF (WMD: -0.84, 95% CI: -2.91 to 1.24). Conclusions: The comparison between ACEI/ARB and controls showed that the former type of drug causes a greater reduction in LVMI with hemodialysis patients, although they have no significant impact on the EF. Compared with other antihypertensive drugs or placebo, ACEI/ARB is recommended as a better choice in hemodialysis patients. (C) 2016 Elsevier Ireland Ltd. All rights reserved.