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

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

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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 m2), 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 m2. 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.

Original languageEnglish
Pages (from-to)150-161
Number of pages12
JournalAmerican Journal of Medicine
Volume126
Issue number2
DOIs
StatePublished - Feb 1 2013

Keywords

  • Angiotensin receptor blockers
  • Angiotensin-converting enzyme inhibitors
  • Chronic kidney disease
  • Diastolic heart failure

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    Ahmed, A., Rich, M. W., Zile, M., Sanders, P. W., Patel, K., Zhang, Y., Aban, I. B., Love, T. E., Fonarow, G. C., Aronow, W. S., & Allman, R. M. (2013). Renin-angiotensin inhibition in diastolic heart failure and chronic kidney disease. American Journal of Medicine, 126(2), 150-161. https://doi.org/10.1016/j.amjmed.2012.06.031