TY - JOUR
T1 - Use of renin-angiotensin inhibitors in people with renal artery stenosis
AU - Evans, Kaleigh L.
AU - Tuttle, Katherine R.
AU - Folt, David A.
AU - Dawson, Taylor
AU - Haller, Steven T.
AU - Brewster, Pamela S.
AU - He, Wencan
AU - Jamerson, Kenneth
AU - Dworkin, Lance D.
AU - Cutlip, Donald E.
AU - Murphy, Timothy P.
AU - D’Agostino, Ralph B.
AU - Henrich, William
AU - Cooper, Christopher J.
N1 - Publisher Copyright:
© 2014 by the American Society of Nephrology.
PY - 2014
Y1 - 2014
N2 - Background and objectives People with atherosclerotic renal artery stenosis may benefit from renin-angiotensin inhibitors, angiotensin-converting enzyme inhibitors, and angiotensin-receptor blockers, but little is known about the factors associated with their use. Design, setting, participants, & measurements The Cardiovascular Outcomes in Renal Atherosclerotic Lesions study (ClinicalTrials.gov identified: NCT00081731) is a prospective, international, multicenter clinical trial that randomly assigned participants with atherosclerotic renal artery stenosis who received optimalmedical therapy to stenting versus no stenting from May 2005 through January 2010. At baseline, medication information was available from 853 of 931 randomly assigned participants. Kidney function was measured by serum creatinine– based eGFR at a core laboratory. Results Before randomization, renin-angiotensin inhibitorswere used in 419 (49%) of the 853 participants. Reninangiotensin inhibitor use was lower in those with CKD (eGFR,60 ml/min per 1.73 m2) (58% versus 68%; P=0.004) and higher in individuals with diabetes (41% versus 27%; P,0.001). Presence of bilateral renal artery stenosis or congestive heart failure was not associated with renin-angiotensin inhibitor use. Although therapy with renin-angiotensin inhibitors varied by study site, differences in rates of use were not related to the characteristics of the site participants. Participants receiving a renin-angiotensin inhibitor had lower systolic BP (mean6SD, 148623 versus 152623 mmHg; P=0.003) and more often had BP at goal (30% versus 22%; P=0.01). Conclusions Kidney function and diabetes were associated with renin-angiotensin inhibitor use. However, these or other clinical characteristics did not explain variability among study sites. Patients with renal artery stenosis who received renin-angiotensin inhibitor treatment had lower BP and were more likely to be at treatment goal.
AB - Background and objectives People with atherosclerotic renal artery stenosis may benefit from renin-angiotensin inhibitors, angiotensin-converting enzyme inhibitors, and angiotensin-receptor blockers, but little is known about the factors associated with their use. Design, setting, participants, & measurements The Cardiovascular Outcomes in Renal Atherosclerotic Lesions study (ClinicalTrials.gov identified: NCT00081731) is a prospective, international, multicenter clinical trial that randomly assigned participants with atherosclerotic renal artery stenosis who received optimalmedical therapy to stenting versus no stenting from May 2005 through January 2010. At baseline, medication information was available from 853 of 931 randomly assigned participants. Kidney function was measured by serum creatinine– based eGFR at a core laboratory. Results Before randomization, renin-angiotensin inhibitorswere used in 419 (49%) of the 853 participants. Reninangiotensin inhibitor use was lower in those with CKD (eGFR,60 ml/min per 1.73 m2) (58% versus 68%; P=0.004) and higher in individuals with diabetes (41% versus 27%; P,0.001). Presence of bilateral renal artery stenosis or congestive heart failure was not associated with renin-angiotensin inhibitor use. Although therapy with renin-angiotensin inhibitors varied by study site, differences in rates of use were not related to the characteristics of the site participants. Participants receiving a renin-angiotensin inhibitor had lower systolic BP (mean6SD, 148623 versus 152623 mmHg; P=0.003) and more often had BP at goal (30% versus 22%; P=0.01). Conclusions Kidney function and diabetes were associated with renin-angiotensin inhibitor use. However, these or other clinical characteristics did not explain variability among study sites. Patients with renal artery stenosis who received renin-angiotensin inhibitor treatment had lower BP and were more likely to be at treatment goal.
UR - http://www.scopus.com/inward/record.url?scp=84912129121&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84912129121&partnerID=8YFLogxK
U2 - 10.2215/CJN.11611113
DO - 10.2215/CJN.11611113
M3 - Article
C2 - 24903387
AN - SCOPUS:84912129121
SN - 1555-9041
VL - 9
SP - 1199
EP - 1206
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 7
ER -