Renin-angiotensin inhibition in systolic heart failure and chronic kidney disease.
Renin-angiotensin inhibition in systolic heart failure and chronic kidney disease.
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DOI：
10.1016/j.amjmed.2011.10.013
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发表时间：
2012-04
影响因子：
5.9
通讯作者：
Rich, Michael W.
中科院分区：
文献类型：
--
作者：
Ahmed, Ali;Fonarow, Gregg C.;Zhang, Yan;Sanders, Paul W.;Allman, Richard M.;Arnett, Donna K.;Feller, Margaret A.;Love, Thomas E.;Aban, Inmaculada B.;Levesque, Raynald;Ekundayo, O. James;Dell'Italia, Louis J.;Bakris, George L.;Rich, Michael W.
关键词：
肾素-血管紧张素抑制剂在老年慢性肾脏病收缩性心力衰竭患者中的作用尚不清楚。在1665例年龄≥65岁的收缩性心力衰竭（射血分数<45%）和慢性肾脏疾病（估计肾小球滤过率<60 ml/min/1.73 m2）患者中，1046例接受了血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗。对1665名患者中的每一名患者估计接受这些药物的倾向评分，用于收集444对接受和未接受这些药物的患者的匹配队列，这些患者在56个基线特征上保持平衡。在超过8年的随访中，接受和未接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的匹配慢性肾脏疾病患者的全因死亡率分别为75%和79%（风险比{HR}，0.86; 95%置信区间{CI}，0.74-0.996; p=0.045）。与心力衰竭住院无显著相关性（HR，0.86; 95% CI，0.72-1.03; p=0.094）。在估计肾小球滤过率<45 ml/min/1.73 m2的匹配患者亚组中，死亡率降低相似（HR，0.83; 95% CI，0.70-1.00; p=0.046）。在171对无慢性肾脏疾病的倾向匹配患者中，使用这些药物与全因死亡率（HR，0.72; 95% CI，0.55-0.94; p=0.015）和心力衰竭住院率（HR，0.71; 95% CI，0.52-0.95; p=0.023）显著降低相关。出院处方血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂与老年慢性肾脏病收缩性心力衰竭患者（包括更晚期慢性肾脏病患者）的全因死亡率显著适度降低相关。
The role of renin-angiotensin inhibition in older systolic heart failure patients with chronic kidney disease remains unclear. Of the 1665 patients, age ≥65 years, with systolic heart failure (ejection fraction <45%) and chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73 m2), 1046 received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Propensity scores for the receipts of these drugs, estimated for each of the 1665 patients, were used to assemble a matched cohort of 444 pairs of patients receiving and not receiving these drugs who were balanced on 56 baseline characteristics. During over 8 years of follow-up, all-cause mortality occurred in 75% and 79% of matched patients with chronic kidney disease receiving and not receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, respectively (hazard ratio {HR}, 0.86; 95% confidence interval {CI}, 0.74–0.996; p=0.045). There was no significant association with heart failure hospitalization (HR, 0.86; 95% CI, 0.72–1.03; p=0.094). Similar mortality reduction (HR, 0.83; 95% CI, 0.70–1.00; p=0.046) occurred in a subgroup of matched patients with estimated glomerular filtration rate <45 ml/min/1.73 m2. Among 171 pairs of propensity-matched patients without chronic kidney disease, the use of these drugs was associated with significant reduction in all-cause mortality (HR, 0.72; 95% CI, 0.55–0.94; p=0.015) and heart failure hospitalization (HR, 0.71; 95% CI, 0.52–0.95; p=0.023). Discharge prescription of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant modest reduction in all-cause mortality in older systolic heart failure patients with chronic kidney disease including those with more advanced chronic kidney disease.
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DOI：
10.1046/j.1532-5415.2002.50457.x
发表时间：
2002-10-01
影响因子：
6.3
作者：
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通讯作者：
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影响因子：
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2.8
作者：
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Shlipak, Michael G.
影响因子：
4.8
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Perry, GJ