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Renin-Angiotensin system modulators modestly reduce vascular risk in persons with prior stroke.

ABSTRACT: Although the efficacy of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in reducing future vascular events for patients with coronary heart disease is established, less is known about the precise benefit of these agents among patients with stroke. We evaluated whether use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers reduces future vascular events in persons with prior stroke.We searched PubMed, Cochrane Central Register of Controlled Trials, and bibliographies of relevant trials and recent review articles to identify randomized controlled trials. Relative risk with 95% CI was used as a measure of the association between use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and risks of major vascular event (nonfatal stroke, nonfatal myocardial infarction, or death from cardiovascular causes) or stroke (ischemic or hemorrhagic) after pooling data across trials.Eight randomized controlled trials with 29 667 participants were identified. Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in persons with prior stroke was associated with lower risks of future major vascular events (relative risk, 0.91; 95% CI, 0.87-0.97; P=0.001; number needed to treat=71) and recurrent stroke (relative risk, 0.93; 95% CI, 0.86-0.99; P=0.03; number needed to treat=143). Heterogeneity was found among studies for end points of major vascular events (P=0.02, I(2)=61%) but not recurrent stroke (P=0.38, I(2)=6%). In subgroup analyses, there was generally no obvious heterogeneity among different study characteristics.Treatment with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker has a clear but rather modest effect on reducing vascular risk in persons with prior stroke.

SUBMITTER: Lee M

PROVIDER: S-EPMC4134883 | biostudies-literature | 2012 Jan

REPOSITORIES: biostudies-literature

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Renin-Angiotensin system modulators modestly reduce vascular risk in persons with prior stroke.

Lee Meng M Saver Jeffrey L JL Hong Keun-Sik KS Hao Qing Q Chow Jessica J Ovbiagele Bruce B

Stroke 20111103 1

<h4>Background and purpose</h4>Although the efficacy of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in reducing future vascular events for patients with coronary heart disease is established, less is known about the precise benefit of these agents among patients with stroke. We evaluated whether use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers reduces future vascular events in persons with prior stroke.<h4>Methods</h4>We searched Pub ...[more]

PMID: 22052520

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Project description:ImportanceIt is uncertain whether and when angiotensin-converting enzyme inhibitor (ACE-I) and angiotensin II receptor blocker (ARB) treatment should be discontinued in individuals with low estimated glomerular filtration rate (eGFR).ObjectiveTo investigate the association of ACE-I or ARB therapy discontinuation after eGFR decreases to below 30 mL/min/1.73 m2 with the risk of mortality, major adverse cardiovascular events (MACE), and end-stage kidney disease (ESKD).Design, setting, and participantsThis retrospective, propensity score-matched cohort study included 3909 patients from an integrated health care system that served rural areas of central and northeastern Pennsylvania. Patients who initiated ACE-I or ARB therapy from January 1, 2004, to December 31, 2018, and had an eGFR decrease to below 30 mL/min/1.73 m2 during therapy were enrolled, with follow-up until January 25, 2019.ExposuresIndividuals were classified based on whether they discontinued ACE-I or ARB therapy within 6 months after an eGFR decrease to below 30 mL/min/1.73 m2.Main outcomes and measuresThe association between ACE-I or ARB therapy discontinuation and mortality during the subsequent 5 years was assessed using multivariable Cox proportional hazards regression models, adjusting for patient characteristics at the time of the eGFR decrease in a propensity score-matched sample. Secondary outcomes included MACE and ESKD.ResultsOf the 3909 individuals receiving ACE-I or ARB treatment who experienced an eGFR decrease to below 30 mL/min/1.73 m2 (2406 [61.6%] female; mean [SD] age, 73.7 [12.6] years), 1235 discontinued ACE-I or ARB therapy within 6 months after the eGFR decrease and 2674 did not discontinue therapy. A total of 434 patients (35.1%) who discontinued ACE-I or ARB therapy and 786 (29.4%) who did not discontinue therapy died during a median follow-up of 2.9 years (interquartile range, 1.3-5.0 years). In the propensity score-matched sample of 2410 individuals, ACE-I or ARB therapy discontinuation was associated with a higher risk of mortality (hazard ratio [HR], 1.39; 95% CI, 1.20-1.60]) and MACE (HR, 1.37; 95% CI, 1.20-1.56), but no statistically significant difference in the risk of ESKD was found (HR, 1.19; 95% CI, 0.86-1.65).Conclusions and relevanceThe findings suggest that continuing ACE-I or ARB therapy in patients with declining kidney function may be associated with cardiovascular benefit without excessive harm of ESKD.

Dataset Information

Renin-Angiotensin system modulators modestly reduce vascular risk in persons with prior stroke.

Publications

Renin-Angiotensin system modulators modestly reduce vascular risk in persons with prior stroke.

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