Why the study?
Guidelines recommend an ACE inhibitor or ARB for elevated albuminuria, but how albuminuria test results relate to the prescription of ACE inhibitor/ARB was uncertain.
Are higher albuminuria levels associated with increased prescription of ACE inhibitors or ARBs?
Observational (n=67,237)
Are higher albuminuria levels associated with increased prescription of ACE inhibitors or ARBs?
Clinicians increasingly initiate ACE inhibitors/ARBs with rising albuminuria; extends real-world support for albuminuria-guided hypertension guidelines.
Multiple clinical guidelines recommend an ACE (angiotensin-converting enzyme) inhibitor or angiotensin II receptor blocker (ARB) in patients with elevated albuminuria, which can be measured through urine albumin-to-creatinine ratio (ACR), protein-to-creatinine ratio, or dipstick. However, how albuminuria test results relate to the prescription of ACE inhibitor/ARB is uncertain. We identified individuals with an ACR measurement between January 1, 2004, and June 30, 2018, and no contraindications or allergy to ACE inhibitor/ARB. We performed multivariable logistic regression analyses to evaluate the association between ACR level and prescription of ACE inhibitor/ARB within 6 months after the test. We applied similar methods to investigate the association of protein-to-creatinine ratio and dipstick measurement results with the prescription of ACE inhibitor/ARB. Among 67 237 individuals with an ACR measurement, 47.7% were already taking an ACE inhibitor or ARB at the time of first ACR measurement. Among the 35 138 individuals who were not on ACE inhibitor/ARB, those with higher ACR levels were more likely to be prescribed ACE inhibitor/ARB in the following 6 months, with steep increases in prescriptions until ACR 300 mg/g, after which the association plateaued. The majority (80.9%) of ACE inhibitor/ARB prescriptions were made by family medicine and internal medicine. A similar pattern held in the cohorts tested by protein-to-creatinine ratio and dipstick measurement. Our study provides evidence that albuminuria test results change patient care, suggesting that adherence to albuminuria testing is a key step in optimal medical management.
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Qiao et al. (2020) conducted an observational in Albuminuria (n=67,237). Albuminuria testing (ACR, protein-to-creatinine ratio, or dipstick) was evaluated on Prescription of ACE inhibitor/ARB within 6 months after the test. Higher albuminuria levels were associated with an increased likelihood of ACE inhibitor or ARB prescription within 6 months, with steep increases in prescriptions up to an ACR of 300 mg/g.
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