Cardiac Effects of Renin-Angiotensin System Inhibitors in Nonproteinuric CKD.

Autor:	Shulman RS; Renal-Electrolyte and Hypertension Division (R.S.S., D.L.C., P.P.R., J.B.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA., Yang W; Department of Biostatistics, Epidemiology, and Informatics (W.Y., P.P.R., J.B.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA., Cohen DL; Renal-Electrolyte and Hypertension Division (R.S.S., D.L.C., P.P.R., J.B.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA., Reese PP; Renal-Electrolyte and Hypertension Division (R.S.S., D.L.C., P.P.R., J.B.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.; Department of Biostatistics, Epidemiology, and Informatics (W.Y., P.P.R., J.B.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA., Cohen JB; Renal-Electrolyte and Hypertension Division (R.S.S., D.L.C., P.P.R., J.B.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.; Department of Biostatistics, Epidemiology, and Informatics (W.Y., P.P.R., J.B.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Jazyk:	angličtina
Zdroj:	Hypertension (Dallas, Tex. : 1979) [Hypertension] 2024 Oct; Vol. 81 (10), pp. 2082-2090. Date of Electronic Publication: 2024 Aug 01.
DOI:	10.1161/HYPERTENSIONAHA.124.23184
Abstrakt:	Background: In contrast to proteinuric chronic kidney disease (CKD), the relative cardioprotective benefits of antihypertensive medications in nonproteinuric CKD are unknown. We examined long-term cardiovascular outcomes and mortality in patients with nonproteinuric CKD treated with renin-angiotensin system inhibitors (RASIs) versus other antihypertensive medications. Methods: Among participants of the CRIC study (Chronic Renal Insufficiency Cohort) without proteinuria, we used intention-to-treat analyses with inverse probability of treatment weighting and Cox proportional hazards modeling to determine the association of RASIs versus other antihypertensive medications with a composite cardiovascular outcome (myocardial infarction, stroke, heart failure hospitalization, and death) and mortality. Secondary analyses included per-protocol analyses accounting for continuous adherence and time-updated analyses accounting for the proportion of time using RASIs during follow-up. Results: A total of 2806 participants met the inclusion criteria. In the intention-to-treat analyses, RASIs versus other antihypertensive medications were not associated with an appreciable difference in cardiovascular events (adjusted hazard ratio [aHR], 0.94 [95% CI, 0.80-1.11]) or mortality (aHR, 1.06 [95% CI, 0.88-1.28]). In the per-protocol analyses, RASIs were associated with a lower risk of adverse cardiovascular events (aHR, 0.78 [95% CI, 0.63-0.97]) and mortality (aHR, 0.64 [95% CI, 0.48-0.85]). Similarly, in the time-updated analyses, a higher proportion of RASI use over time was associated with a lower mortality risk (aHR, 0.33 [95% CI, 0.14-0.86]). Conclusions: Among individuals with nonproteinuric CKD, after accounting for time-updated use, RASIs are associated with fewer cardiovascular events and a lower mortality risk compared with other antihypertensive medications. Patients with nonproteinuric CKD may benefit from prioritizing RASIs for hypertension management. Competing Interests: None.
Databáze:	MEDLINE
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