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Use of renin-angiotensin inhibitors in people with renal artery stenosis.

Authors :: Evans KL
Tuttle KR
Folt DA
Dawson T
Haller ST
Brewster PS
He W
Jamerson K
Dworkin LD
Cutlip DE
Murphy TP
D'Agostino RB Sr
Henrich W
Cooper CJ
Source :: Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2014 Jul; Vol. 9 (7), pp. 1199-206. Date of Electronic Publication: 2014 Jun 05.
Publication Year :: 2014
Abstract: 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.<br />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 optimal medical 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.<br />Results: Before randomization, renin-angiotensin inhibitors were used in 419 (49%) of the 853 participants. Renin-angiotensin inhibitor use was lower in those with CKD (eGFR<60 ml/min per 1.73 m(2)) (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 (mean ± SD, 148 ± 23 versus 152 ± 23 mmHg; P=0.003) and more often had BP at goal (30% versus 22%; P=0.01).<br />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.<br /> (Copyright © 2014 by the American Society of Nephrology.)