Clinical InvestigationCoronary Artery DiseaseAngiotensin inhibition in renovascular disease: A population-based cohort study
Section snippets
Setting
The sampling region for the study was the province of Ontario, Canada. Residents of Ontario who are 65 years or older have universal access to hospital care, physician services, and prescription drug coverage, with associated records entered into population-wide administrative databases. The study was approved by the Sunnybrook Health Sciences Ethics Board. The design and reporting of the protocol adhered to stringent observational research guidelines.15, 16
Data sources
We used 4 large administrative
Results
A total of 3,570 patients were enrolled in the study between 1994 and 2005; slightly more than half (n = 1,877, 53%) were treated with angiotensin inhibitors. The diagnosis of RVD was confirmed by duplex sonography in 52%, computerized tomographic angiography in 19%, renal angiography in 20%, and captopril renography in 18%; many patients had multiple imaging procedures. Cardiovascular risk factors and comorbidities were common with high rates of hypertension, chronic kidney disease, peripheral
Discussion
The presence of significant RVD has been viewed by many as a relative contraindication to the use of angiotensin inhibitors.38, 39, 40 Documented virtually since their introduction to market, cases of acute renal failure have been reported after initiation of angiotensin inhibitors in this setting.41, 42 Yet, several experts have called for broader use of angiotensin inhibitors in RVD and in the largest ongoing trial in this area, the Cardiovascular Outcomes in Renal Atherosclerotic Lesions
References (57)
- et al.
Prevalence of renovascular disease in the elderly: a population-based study
J Vasc Surg
(2002) - et al.
Diffusion of new technology for the treatment of renovascular hypertension in the United States: surgical revascularization versus catheter-based therapy, 1988-2001
J Vasc Surg
(2004) - et al.
Incidence trends and mortality in end-stage renal disease attributed to renovascular disease in the United States
Am J Kidney Dis
(2001) - et al.
Atherosclerotic renovascular disease in United States patients aged 67 years or older: risk factors, revascularization, and prognosis
Kidney Int
(2005) - et al.
Prevention of events with angiotensin-converting enzyme inhibition (the PEACE study design)
Am J Cardiol
(1998) - et al.
A multicenter study of the coding accuracy of hospital discharge administrative data for patients admitted to cardiac care units in Ontario
Am Heart J
(2002) - et al.
Severity of renal vascular disease predicts mortality in patients undergoing coronary angiography
Kidney Int
(2001) - et al.
Potassium disorders—clinical spectrum and emergency management
Resuscitation
(2006) ACE inhibitors and unilateral renal artery stenosis—what price?
Int J Cardiol
(1996)- et al.
Stent revascularization for the prevention of cardiovascular and renal events among patients with renal artery stenosis and systolic hypertension: rationale and design of the CORAL trial
Am Heart J
(2006)
Blood pressure, antihypertensive medication, and atherosclerotic renal artery stenosis
Am J Kidney Dis
Comparison of effects of enalapril plus hydrochlorothiazide versus standard triple therapy on renal function in renovascular hypertension
Am J Med
Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on renal outcomes: systematic review and meta-analysis
Lancet
High-risk patients treated with enalapril maleate: safety considerations
Int J Cardiol
Angiotensin converting enzyme inhibitor-induced renal dysfunction in atherosclerotic renovascular disease
Kidney Int
Angiotensin converting enzyme inhibition in renovascular hypertension: frequency of reversible renal failure
Lancet
Atherosclerotic renovascular disease in older US patients starting dialysis, 1996 to 2001
Circulation
Atherosclerotic renal artery stenosis, ACE inhibitors, and avoiding cardiovascular death
Heart
Treatment options for renovascular hypertension
Expert Opin Pharmacother
Angiotensin-converting enzyme inhibitor usage in patients with incidental atherosclerotic renal artery stenosis
Hypertension Research-Clinical & Experimental
The role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension
Hypertension
Taking precautions with ACE inhibitors. A theoretical risk exists in patients with unilateral renal artery stenosis
BMJ
Late onset renal failure from angiotensin blockade (LORFFAB): a prospective thirty-month Mayo Health System clinic experience
Med Sci Monit
The HOPE (Heart Outcomes Prevention Evaluation) Study: the design of a large, simple randomized trial of an angiotensin-converting enzyme inhibitor (ramipril) and vitamin E in patients at high risk of cardiovascular events. The HOPE study investigators
Can J Cardiol
The EUROPA Trial: design, baseline demography and status of the substudies
Cardiovascular Drugs and Therapy
Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement
Am J Public Health
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
Ann Intern Med
Coding accuracy of administrative drug claims in the Ontario Drug Benefit database
Can J Clin Pharmacol
Cited by (0)
The study was supported by an unrestricted research grant from the University of Western Ontario, London, Ontario, Canada. None of the funding sources participated in the design or conduct of the research; collection, management, analysis, or interpretation of the data; or the preparation, review, and approval of the manuscript.
No conflicts of interest exist for D.G.H., M.L.D., M.M., P.L., or A.X.G. J.D.S. has consulted for Novartis and received lecture fees from Solvay. SWT has participated in research studies, advisory panels, and lectures with support from AstraZeneca, Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb, Sanofi-Aventis, Merck, and Novartis.