Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) can reduce mortality in heart failure patients with chronic kidney disease, a retrospective analysis has found.
The researchers note that the role of ACEIs and ARBs in this group of patients is not well established, mainly because clinical trials typically exclude patients with severe renal impairment and physicians are reluctant to initiate either medication in patients with renal impairment due to the fear of precipitating acute renal failure or hyperkalaemia. The underuse of ACEIs and ARBs in this patient group may lead to a poorer prognosis.
The research team retrospectively analysed data from the Minnesota Heart Survey (MHS) to investigate the association of ACEI and ARB use on 30-day, six-month and one-year all-cause mortality in 2,169 patients with CHF, stratified by glomerular filtration rate (GFR).
GFR was estimated using the Cockcroft-Gault equation, using the serum creatinine recorded at the time closest to CHF diagnosis (at time of hospital admission in most cases); stratification was then as follows: stage 1 (90ml/min or above), stage 2 (60