Renin-angiotensin inhibition in systolic heart failure and chronic kidney disease.

Abstract

BACKGROUND:

The role of renin-angiotensin inhibition in older patients with systolic heart failure with chronic kidney disease remains unclear.

METHODS:

Of the 1665 patients (aged≥65 years) with systolic heart failure (ejection fraction<45%) and chronic kidney disease (estimated glomerular filtration rate<60 mL/min/1.73 m(2)), 1046 received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Propensity scores for the receipt of these drugs, estimated for each of the 1665 patients, were used to assemble a matched cohort of 444 pairs of patients receiving and not receiving these drugs who were balanced on 56 baseline characteristics.

RESULTS:

During more than 8 years of follow-up, all-cause mortality occurred in 75% and 79% of matched patients with chronic kidney disease receiving and not receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, respectively (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.74-0.996; P=.045). There was no significant association with heart failure hospitalization (HR, 0.86; 95% CI, 0.72-1.03; P=.094). Similar mortality reduction (HR, 0.83; 95% CI, 0.70-1.00; P=.046) occurred in a subgroup of matched patients with estimated glomerular filtration rate less than 45 mL/min/1.73 m(2). Among 171 pairs of propensity-matched patients without chronic kidney disease, the use of these drugs was associated with a significant reduction in all-cause mortality (HR, 0.72; 95% CI, 0.55-0.94; P=.015) and heart failure hospitalization (HR, 0.71; 95% CI, 0.52-0.95; P=.023).

CONCLUSION:

Discharge prescription of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant modest reduction in all-cause mortality in older patients with systolic heart failure with chronic kidney disease, including those with more advanced chronic kidney disease.

• Authors: Ali Ahmed, Gregg C Fonarow, Yan Zhang, Paul W Sanders, Richard M Allman, Donna K Arnett, Margaret A Feller, Thomas E Love, Inmaculada B Aban, Raynald Levesque, O James Ekundayo, Louis J Dell'Italia, George L Bakris, Michael W Rich
• Journal: The American journal of medicine (Am J Med) Vol. 125 Issue 4 Pg. 399-410 (Apr 2012) ISSN: 1555-7162 [Electronic] United States
• PMID: 22321760 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: Published by Elsevier Inc.

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors

Topics

• Aged
• Aged, 80 and over
• Alabama (epidemiology)
• Angiotensin Receptor Antagonists (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Female
• Heart Failure, Systolic (complications, drug therapy, mortality)
• Hospitalization (statistics & numerical data)
• Humans
• Male
• Renal Insufficiency, Chronic (complications, drug therapy, mortality)
• Renin-Angiotensin System
• Treatment Outcome