Cited by 143Renin-Angiotensin System StudiesRenal and Vascular PathologiesChronic Kidney Disease and Diabetes

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Angiotensin inhibition in renovascular disease: A population-based cohort study

Hackam, Daniel G., Duong-Hua, Minh L., Mamdani, Muhammad, Li, Ping, Tobe, Sheldon W., Spence, J. David, Garg, Amit X.·2008·American Heart Journal

DOI 10.1016/j.ahj.2008.05.013

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Abstract

Background Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers effectively reduce blood pressure in patients with renovascular disease (RVD); yet, randomized cardiovascular prevention trials of these drugs typically exclude individuals with this condition.Patients and methods We studied the association of renin-angiotensin system inhibition with prognosis in a population-based cohort comprising 3,570 patients with RVD in Ontario, Canada; slightly more than half (n = 1,857, 53%) were prescribed angiotensin inhibitors. The primary outcome was the composite of death, myocardial infarction, or stroke. Secondary outcomes included individual cardiovascular and renal events.Results Patients receiving angiotensin inhibitors had a significantly lower risk for the primary outcome during follow-up (10.0 vs 13.0 events per 100 patient-years at risk, multivariable adjusted hazard ratio [HR] 0.70, 95% CI 0.59-0.82). In addition, hospitalization for congestive heart failure (HR 0.69, 95% CI 0.53-0.90), chronic dialysis initiation (HR 0.62, 95% CI 0.42-0.92), and mortality (HR 0.56, 95% CI 0.47-0.68) was lower in treated patients. Conversely, patients receiving angiotensin inhibitors were significantly more likely to be hospitalized for acute renal failure during follow-up (HR 1.87, 95% CI 1.05-3.33; 1.2 vs 0.6 events per 100 patient-years at risk).Conclusions These data emphasize the high vascular risk of RVD and suggest that angiotensin inhibitors may improve prognosis in this setting at the expense of acute renal toxicity. If the latter are selected in the management of RVD, renal function parameters should be assiduously followed.

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Authors: Hackam, D. G., Duong-Hua, M. L., Mamdani, M., Li, P., Tobe, S. W., Spence, J. D., & Garg, A. X.
Affiliations: Western University (CA)
Institute for Clinical Evaluative Sciences (CA)
University of Toronto (CA)
Corresponding author: Hackam, Daniel G.
ORCID: Hackam, Daniel G.
Mamdani, Muhammad
Li, Ping
Tobe, Sheldon W.
Spence, J. David
Garg, Amit X.
Venue: American Heart Journal
Publisher: Elsevier BV
Published: 2008-09
Volume: 156
Issue: 3
Pages: 549-555
ISSN: 0002-8703 (ISSN-L)
DOI: 10.1016/j.ahj.2008.05.013
OpenAlex: W1976834810
Cited by: 143
References: 57
Citations by year: 2026: 3 · 2025: 1 · 2024: 8 · 2023: 7 · 2022: 4 · 2021: 3 · 2020: 3 · 2019: 7 · 2018: 12 · 2017: 6 · 2016: 12 · 2015: 8 · 2014: 16 · 2013: 9 · 2012: 13
FWCI: 7.28
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: American Heart Journal (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
Health Sciences › Medicine › Nephrology › Renal and Vascular Pathologies
Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords: renovascular disease, ACE inhibitors, angiotensin receptor blockers, renin-angiotensin system blockade, cardiovascular outcomes, acute kidney injury, congestive heart failure, dialysis initiation, mortality, stroke, myocardial infarction, renal function monitoring
MeSH terms: Aged, Aged, 80 and over, Angiotensins, Cardiovascular Diseases, Female, Follow-Up Studies, Heart Failure, Renal Dialysis, Hormone Antagonists, Hospitalization, Humans, Kidney, Kidney Diseases, Male, Myocardial Infarction, Renin-Angiotensin System, Vascular Diseases, Cohort Studies, Proportional Hazards Models, Risk Assessment, Stroke, Acute Kidney Injury

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Angiotensin inhibition in renovascular disease: A population-based cohort study

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