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Renin-angiotensin inhibition in systolic heart failure and chronic kidney disease.
- Source :
-
The American journal of medicine [Am J Med] 2012 Apr; Vol. 125 (4), pp. 399-410. Date of Electronic Publication: 2012 Feb 07. - Publication Year :
- 2012
-
Abstract
- Background: The role of renin-angiotensin inhibition in older patients with systolic heart failure with chronic kidney disease remains unclear.<br />Methods: Of the 1665 patients (agedā„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.<br />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).<br />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.<br /> (Published by Elsevier Inc.)
- Subjects :
- Aged
Aged, 80 and over
Alabama epidemiology
Female
Heart Failure, Systolic complications
Heart Failure, Systolic mortality
Hospitalization statistics & numerical data
Humans
Male
Renal Insufficiency, Chronic complications
Renal Insufficiency, Chronic mortality
Renin-Angiotensin System
Treatment Outcome
Angiotensin Receptor Antagonists therapeutic use
Angiotensin-Converting Enzyme Inhibitors therapeutic use
Heart Failure, Systolic drug therapy
Renal Insufficiency, Chronic drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1555-7162
- Volume :
- 125
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The American journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 22321760
- Full Text :
- https://doi.org/10.1016/j.amjmed.2011.10.013