Key result
New use of ACE inhibitors in patients initiating maintenance dialysis was associated with a higher risk of all-cause mortality compared to ARBs (AHR 1.22; 99% CI 1.05-1.42).
Why the study?
Does new use of ACEI compared to ARB reduce all-cause mortality and cardiovascular events in hypertensive patients initiating maintenance dialysis?
Cohort (n=4,997)
Yes
Does new use of ACEI compared to ARB reduce all-cause mortality and cardiovascular events in hypertensive patients initiating maintenance dialysis?
In hypertensive patients initiating maintenance dialysis, new use of ACE inhibitors was associated with a higher risk of all-cause mortality compared to ARBs.
Answers are grounded in this paper and cite their sources.
ACEI initiation may raise mortality risk versus ARBs in new dialysis patients; leaves open need for RCTs before practice change.
BACKGROUND/AIMS: Whether angiotensin converting enzyme inhibitors (ACE) and angiotensin receptor blockers (ARB) are differentially associated with reductions in cardiovascular events and mortality in patients receiving maintenance dialysis is uncertain. We compared outcomes between ACE and ARB users among hypertensive, maintenance dialysis patients. METHODS: National retrospective cohort study of hypertensive, Medicare-Medicaid eligible patients initiating chronic dialysis between 1/1/2000 to 12/31/2005. The exposure of interest was new use of either an ACEI or ARB. Outcomes were all-cause mortality (ACM) and combined cardiovascular hospitalization or death (CV-endpoint). Cox proportion hazards models were used to compare the effect of ACEI vs ARB use on ACM and, separately, CV-endpoint. RESULTS: ACM models were based on 3,555 ACEI and 1,442 ARB new users, while CV-endpoint models included 3,289 ACEI and 1,346 ARB new users. After statistical adjustments, ACEI users had higher hazard ratios for ACM (AHR = 1.22, 99% CI 1.05-1.42) and CV-endpoint (AHR = 1.12, 99% CI 0.99-1.27). CONCLUSIONS: Patients initiating maintenance dialysis who received an ACEI faced an increased risk for mortality and a trend towards an increased risk for CV-endpoints when compared to patients who received an ARB. Validation of these results in a rigorous clinical trial is warranted.
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Shireman et al. (2016) conducted a cohort in Hypertension and maintenance dialysis (n=4,997). Angiotensin converting enzyme inhibitors (ACEI) vs. Angiotensin receptor blockers (ARB) was evaluated on All-cause mortality (AHR 1.22, 95% CI 1.05-1.42). New use of ACE inhibitors in patients initiating maintenance dialysis was associated with a higher risk of all-cause mortality compared to ARBs (AHR 1.22; 99% CI 1.05-1.42).
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