Ramipril did not reduce major cardiovascular events in patients on maintenance hemodialysis, but increased hypotensive episodes (41% vs 12%) and cancer cases (20 vs 9).
RCT (n=269)
open-label, blinded end point
randomized
Yes
Does ramipril reduce the composite of cardiovascular death, myocardial infarction, or stroke in patients on maintenance hemodialysis with hypertension and/or left ventricular hypertrophy?
In patients on maintenance hemodialysis, ramipril did not reduce major cardiovascular events and was associated with higher rates of hypotension.
BACKGROUND AND OBJECTIVES: Renin-angiotensin system (RAS) inhibitors reduce cardiovascular morbidity and mortality in patients with CKD. We evaluated the cardioprotective effects of the angiotensin-converting enzyme inhibitor ramipril in patients on maintenance hemodialysis. DESIGN, SETTING, PARTICIPANTS, 95% confidence interval, -29.4 to -3.1), but did not significantly affect the other secondary outcomes. Hypotensive episodes were more frequent in participants allocated to ramipril than controls (41% versus 12%). Twenty participants on ramipril and nine controls developed cancer, including six gastrointestinal malignancies on ramipril (four were fatal), compared with none in controls. CONCLUSIONS: Ramipril did not reduce the risk of major cardiovascular events in patients on maintenance hemodialysis. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: ARCADIA, NCT00985322 and European Union Drug Regulating Authorities Clinical Trials Database number 2008-003529-17.
Ruggenenti et al. (Mon,) conducted a rct in maintenance hemodialysis (n=269). Ramipril vs. non-RAS inhibition therapy was evaluated on composite of cardiovascular death, myocardial infarction, or stroke. Ramipril did not reduce major cardiovascular events in patients on maintenance hemodialysis, but increased hypotensive episodes (41% vs 12%) and cancer cases (20 vs 9).
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