Renin-Angiotensin Inhibition in Diastolic Heart Failure and Chronic Kidney Disease
详细信息    查看全文
文摘

Background

The role of renin-angiotensin inhibition in older patients with diastolic heart failure and chronic kidney disease remains unclear.

Methods

Of the 1340 patients (age ¡Ý 65 years) with diastolic heart failure (ejection fraction ¡Ý 45 % ) and chronic kidney disease (estimated glomerular filtration rate < 60 mL/min/1.73 m2), 717 received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Propensity scores for the use of these drugs, estimated for each of the 1340 patients, were used to assemble a cohort of 421 pairs of patients, receiving and not receiving these drugs, who were balanced on 56 baseline characteristics.

Results

During more than 8 years of follow-up, all-cause mortality occurred in 63 % and 69 % of matched patients with chronic kidney disease receiving and not receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, respectively (hazard ratio [HR], 0.82; 95 % confidence interval [CI], 0.70-0.97; P = .021). There was no association with heart failure hospitalization (HR, 0.98; 95 % CI, 0.82-1.18; P = .816). Similar mortality reduction (HR, 0.81; 95 % CI, 0.66-0.995; P = .045) occurred in a subgroup of matched patients with an estimated glomerular filtration rate less than 45 mL/min/1.73 m2. Among 207 pairs of propensity-matched patients without chronic kidney disease, the use of these drugs was not associated with mortality (HR, 1.03; 95 % CI, 0.80-1.33; P = .826) or heart failure hospitalization (HR, 0.99; 95 % CI, 0.76-1.30; P = .946).

Conclusions

A discharge prescription for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant reduction in all-cause mortality in older patients with diastolic heart failure and chronic kidney disease, including those with more advanced chronic kidney disease.

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址:北京市海淀区学院路29号 邮编:100083

电话:办公室:(+86 10)66554848;文献借阅、咨询服务、科技查新:66554700