Association of Angiotensin Modulators With the Course of Idiopathic Pulmonary Fibrosis
Association of Angiotensin Modulators With the Course of Idiopathic Pulmonary Fibrosis
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DOI：
10.1016/j.chest.2019.04.015
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发表时间：
2019-10-01
期刊：
影响因子：
9.6
通讯作者：
Cottin, Vincent
中科院分区：
文献类型：
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作者：
Kreuter, Michael;Lederer, David J.;Cottin, Vincent
血管紧张素肽与特发性肺纤维化（IPF）发病机制有关。血管紧张素调节剂用于治疗动脉高血压（IPF的常见合并症）。该事后分析评估了IPF.METHODS中抗高血压治疗与疾病相关结局的相关性：CAPACITY和ASCEND研究中随机分配至安慰剂组的所有患者（n = 624）均按基线抗高血压治疗进行分类。疾病进展结局（首次发生%预测FVC绝对下降>= 10%，6分钟步行距离下降>= 50米，或死亡）和全因死亡率在52 wk内进行评估。结果：基线时，111和121例患者分别接受血管紧张素转换酶抑制剂（ACEi）或血管紧张素II受体阻滞剂（ARB）;第392章都没收到在校正基线特征差异后的多变量分析中，与非ACEi/ARB组相比，ACEi治疗（风险比[HR]，0. 6 [95% CI，0. 4 - 0. 9]; P = 0. 026）与疾病进展较慢相关，而ARB治疗（HR，0. 9 [95% CI，0. 6 - 1. 2]; P = 0. 413）与疾病进展较慢相关。此外，在ACEi组中未观察到与心血管疾病相关的全因死亡率增加（HR，1.1 [95% CI，0.5-2.9]; P = 0.782），其IPF相关死亡率百分比与非ACEi/ARB组相似（3.6% vs 3.6%）。相反，ARB组患者的全因死亡风险更高（HR，2.5 [95% CI，1.2-5.2]）。这些观察结果在包括INSPIRE试验患者的汇总分析中得到了验证。结论：需要前瞻性临床试验来评估血管紧张素调节剂是否可能对IPF的临床结局有益。
RACKGROUND: Angiotensin peptides have been implicated in idiopathic pulmonary fibrosis (IPF) pathogenesis. Angiotensin modulators are used to treat arterial hypertension, a frequent comorbidity of IPF. This post hoc analysis evaluated associations of antihypertensive treatments with disease-related outcomes in IPF.METHODS: All patients randomized to placebo (n = 624) in the CAPACITY and ASCEND studies were categorized by antihypertensive treatment at baseline. Outcomes of disease progression (first occurrence of >= 10% absolute decline in % predicted FVC, >= 50-m decline in 6-min walk distance, or death) and all-cause mortality were assessed over 52 weeks.RESULTS: At baseline, 111 and 121 patients were receiving an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB), respectively; 392 were receiving neither. In multivariable analyses adjusted for differences in baseline characteristics compared with the non-ACEi/ARB group, ACEi treatment (hazard ratio [HR], 0.6 [95% CI, 0.4-0.9]; P = .026), but not ARB (HR, 0.9 [95% CI, 0.6-1.2]; P = .413), was associated with slower disease progression. Furthermore, the increase in all-cause mortality associated with cardiovascular disease was not observed in the ACEi group (HR, 1.1 [95% CI, 0.5-2.9]; P =.782), which presented a similar percentage of IPF-related mortality as the non-ACEi/ARB group (3.6% vs 3.6%). In contrast, patients in the ARB group had greater risk of all-cause mortality (HR, 2.5 [95% CI, 1.2-5.2]). These observations were validated in a pooled analysis that included patients from the INSPIRE trial.CONCLUSIONS: Prospective clinical trials are needed to evaluate whether angiotensin modulators may be beneficial to clinical outcomes in IPF.