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

Abstract

BACKGROUND:

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

METHODS:

Of the 1340 patients (age ≥65 years) with diastolic heart failure (ejection fraction ≥45%) and chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m(2)), 717 received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Propensity scores for the use of these drugs, estimated for each of the 1340 patients, were used to assemble a cohort of 421 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 63% and 69% of matched patients with chronic kidney disease receiving and not receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, respectively (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.70-0.97; P = .021). There was no association with heart failure hospitalization (HR, 0.98; 95% CI, 0.82-1.18; P = .816). Similar mortality reduction (HR, 0.81; 95% CI, 0.66-0.995; P = .045) occurred in a subgroup of matched patients with an estimated glomerular filtration rate less than 45 mL/min/1.73 m(2). Among 207 pairs of propensity-matched patients without chronic kidney disease, the use of these drugs was not associated with mortality (HR, 1.03; 95% CI, 0.80-1.33; P = .826) or heart failure hospitalization (HR, 0.99; 95% CI, 0.76-1.30; P = .946).

CONCLUSIONS:

A discharge prescription for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant reduction in all-cause mortality in older patients with diastolic heart failure and chronic kidney disease, including those with more advanced chronic kidney disease.

• Authors: Ali Ahmed, Michael W Rich, Michael Zile, Paul W Sanders, Kanan Patel, Yan Zhang, Inmaculada B Aban, Thomas E Love, Gregg C Fonarow, Wilbert S Aronow, Richard M Allman
• Journal: The American journal of medicine (Am J Med) Vol. 126 Issue 2 Pg. 150-61 (Feb 2013) ISSN: 1555-7162 [Electronic] United States
• PMID: 23331442 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Published by Elsevier Inc.

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors

Topics

• Aged
• Aged, 80 and over
• Angiotensin Receptor Antagonists (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Drug Administration Schedule
• Female
• Heart Failure, Diastolic (drug therapy, mortality)
• Humans
• Kidney Failure, Chronic (drug therapy, mortality)
• Male
• Renin-Angiotensin System (drug effects)