HDCN Abstract:  ASN Annual Meeting -- San Francisco  

Jalandhara N, Balamuthusamy S, Srinivasan L, et al.

ACE Inhibition and Cardiovascular Outcomes in Hypertensive Patients with Renal Failure: A Meta-Analysis.

ASN Annual Meeting -- San Francisco
J Am Soc Nephrol (Nov) 18:630A 2007

Objective: Renal failure patients are at increased risk for adverse cardiovascular outcomes. We assessed the mortality and cardiovascular outcomes in renal failure patients with hypertension treated with Angiotensin converting enzyme (ACE) inhibitors or Angiotensin receptor antagonists (ARB).

Methods: Randomized control trials that analyzed hypertensive patients with renal failure in which either ACE inhibitors or ARBs were compared with control antihypertensive therapy are included for analysis. Systematic review of literature was performed with relevant terms using Pubmed, Cochrane database, CINAHL and EMBASE search engines. Chi-square test was used to assess inter-study heterogeneity. The combined relative risk (RR) of all outcomes was computed using the Mantel-Haenszel method with random-effects model. Results were computed using 95% confidence intervals and were considered significant with p<0.05.

Results: 9 trials (N=25,458) fulfilled the inclusion criteria. The RR for heart failure, cardiovascular mortality, myocardial infarction, total mortality and cardiovascular outcomes were 1(0.9-1.1): p=0.8, 0.87 (0.5-1.52): p=0.5, 0.96(0.88-1.05) p=0.5, 1.09(0.44-2.73) p=0.8 and 1.01(0.97-1.06) p=0.13 respectively. The risk for stroke was 1.12(1-1.27) p=0.05 when ACE inhibition was compared to control antihypertensive therapy.

Conclusion: ACE inhibition shows a trend towards an increased risk for stroke in renal failure patients with hypertension when compared to control antihypertensive therapy. There was no significant benefit with ACE inhibition over control therapy in decreasing total mortality or other cardiovascular outcomes in the study population.




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