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Angiotensin inhibition in renovascular disease: A population-based cohort study
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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“Large data registries indicate that ACE inhibitor or ARB treatment in patients with identified renal artery stenosis confers a long-term mortality benefit.317”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [317]
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Metadata
- 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.
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2008-09
- Volume
- 156
- Issue
- 3
- Pages
- 549-555
- ISSN
- 0002-8703 (ISSN-L)
- 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
- 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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