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Angiotensin-Converting Enzyme Inhibitor

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Cheuk-chun Szeto – 1st expert on this subject based on the ideXlab platform

  • effects of an angiotensin converting Enzyme Inhibitor on residual renal function in patients receiving peritoneal dialysis a randomized controlled study
    Annals of Internal Medicine, 2003
    Co-Authors: Philip Kamtao Li, Kaiming Chow, Teresa Yukhwa Wong, Chibon Leung, Cheuk-chun Szeto

    Abstract:

    Background: Residual renal function is an important determinant of mortality and morbidity in patients receiving peritoneal dialysis. However, few studies have evaluated therapeutic approaches for preserving residual renal function after the initiation of dialysis. Objective: To test the hypothesis that the Angiotensin-Converting Enzyme (ACE) Inhibitor ramipril slows the decline in residual renal function in patients with end-stage renal failure treated with peritoneal dialysis. Design: Randomized, open-label, controlled trial. Setting: Single-center study in the dialysis unit of a university teaching hospital. Patients: 60 patients receiving peritoneal dialysis. Measurements: Patients were randomly assigned to ramipril (5 mg daily) or no treatment. The target blood pressure was 135/85 mm Hg or less. Rate of decline in residual glomerular filtration rate (GFR) and development of complete anuria were compared among groups. Results: Over 12 months, average residual GFR declined by 2.07 mUmin per 1.73 m 2 in the ramipril group versus 3.00 mUmin per 1.73 m 2 in the control group (P = 0.03). The difference between the average changes in residual GFR In the ramipril and control groups from baseline to 12 months was 0.93 mUmin per 1.73 m 2 (95% Cl, 0.09 to 1.78 mUmin per 1.73 m 2 ). At 12 months, 14 patients in the ramipril group and 22 in the control group developed anuria. With intention-to-treat multivariable analysis using the Cox model, it was estimated that at 3, 6, and 9 months, patients assigned to ramipril had a higher adjusted hazard of complete anuria than did patients assigned to no treatment. Of the 25 patients who still did not have complete anuria at 12 months, those assigned to ramipril had a better prognosis than did those assigned to no treatment (adjusted hazard ratio, 0.58 [CI, 0.36 to 0.94]). The rates of death from any cause, duration of hospitalization, and cardiovascular events did not differ significantly between groups. Conclusions: Although the trial was small and had a limited ability to exclude effects of potential confounding factors, the Angiotensin-Converting Enzyme Inhibitor ramipril may reduce the rate of decline of residual renal function in patients with end-stage renal failure treated with peritoneal dialysis.

  • effects of an angiotensin converting Enzyme Inhibitor on residual renal function in patients receiving peritoneal dialysis a randomized controlled study
    Annals of Internal Medicine, 2003
    Co-Authors: Philip Kamtao Li, Kaiming Chow, Teresa Yukhwa Wong, Chibon Leung, Cheuk-chun Szeto

    Abstract:

    BACKGROUND: Residual renal function is an important determinant of mortality and morbidity in patients receiving peritoneal dialysis. However, few studies have evaluated therapeutic approaches for preserving residual renal function after the initiation of dialysis. OBJECTIVE: To test the hypothesis that the Angiotensin-Converting Enzyme (ACE) Inhibitor ramipril slows the decline in residual renal function in patients with end-stage renal failure treated with peritoneal dialysis. DESIGN: Randomized, open-label, controlled trial. SETTING: Single-center study in the dialysis unit of a university teaching hospital. PATIENTS: 60 patients receiving peritoneal dialysis. MEASUREMENTS: Patients were randomly assigned to ramipril (5 mg daily) or no treatment. The target blood pressure was 135/85 mm Hg or less. Rate of decline in residual glomerular filtration rate (GFR) and development of complete anuria were compared among groups. RESULTS: Over 12 months, average residual GFR declined by 2.07 mL/min per 1.73 m2 in the ramipril group versus 3.00 mL/min per 1.73 m2 in the control group (P = 0.03). The difference between the average changes in residual GFR in the ramipril and control groups from baseline to 12 months was 0.93 mL/min per 1.73 m2 (95% CI, 0.09 to 1.78 mL/min per 1.73 m2). At 12 months, 14 patients in the ramipril group and 22 in the control group developed anuria. With intention-to-treat multivariable analysis using the Cox model, it was estimated that at 3, 6, and 9 months, patients assigned to ramipril had a higher adjusted hazard of complete anuria than did patients assigned to no treatment. Of the 25 patients who still did not have complete anuria at 12 months, those assigned to ramipril had a better prognosis than did those assigned to no treatment (adjusted hazard ratio, 0.58 [CI, 0.36 to 0.94]). The rates of death from any cause, duration of hospitalization, and cardiovascular events did not differ significantly between groups. CONCLUSIONS: Although the trial was small and had a limited ability to exclude effects of potential confounding factors, the Angiotensin-Converting Enzyme Inhibitor ramipril may reduce the rate of decline of residual renal function in patients with end-stage renal failure treated with peritoneal dialysis.

Philip Kamtao Li – 2nd expert on this subject based on the ideXlab platform

  • effects of an angiotensin converting Enzyme Inhibitor on residual renal function in patients receiving peritoneal dialysis a randomized controlled study
    Annals of Internal Medicine, 2003
    Co-Authors: Philip Kamtao Li, Kaiming Chow, Teresa Yukhwa Wong, Chibon Leung, Cheuk-chun Szeto

    Abstract:

    Background: Residual renal function is an important determinant of mortality and morbidity in patients receiving peritoneal dialysis. However, few studies have evaluated therapeutic approaches for preserving residual renal function after the initiation of dialysis. Objective: To test the hypothesis that the Angiotensin-Converting Enzyme (ACE) Inhibitor ramipril slows the decline in residual renal function in patients with end-stage renal failure treated with peritoneal dialysis. Design: Randomized, open-label, controlled trial. Setting: Single-center study in the dialysis unit of a university teaching hospital. Patients: 60 patients receiving peritoneal dialysis. Measurements: Patients were randomly assigned to ramipril (5 mg daily) or no treatment. The target blood pressure was 135/85 mm Hg or less. Rate of decline in residual glomerular filtration rate (GFR) and development of complete anuria were compared among groups. Results: Over 12 months, average residual GFR declined by 2.07 mUmin per 1.73 m 2 in the ramipril group versus 3.00 mUmin per 1.73 m 2 in the control group (P = 0.03). The difference between the average changes in residual GFR In the ramipril and control groups from baseline to 12 months was 0.93 mUmin per 1.73 m 2 (95% Cl, 0.09 to 1.78 mUmin per 1.73 m 2 ). At 12 months, 14 patients in the ramipril group and 22 in the control group developed anuria. With intention-to-treat multivariable analysis using the Cox model, it was estimated that at 3, 6, and 9 months, patients assigned to ramipril had a higher adjusted hazard of complete anuria than did patients assigned to no treatment. Of the 25 patients who still did not have complete anuria at 12 months, those assigned to ramipril had a better prognosis than did those assigned to no treatment (adjusted hazard ratio, 0.58 [CI, 0.36 to 0.94]). The rates of death from any cause, duration of hospitalization, and cardiovascular events did not differ significantly between groups. Conclusions: Although the trial was small and had a limited ability to exclude effects of potential confounding factors, the Angiotensin-Converting Enzyme Inhibitor ramipril may reduce the rate of decline of residual renal function in patients with end-stage renal failure treated with peritoneal dialysis.

  • effects of an angiotensin converting Enzyme Inhibitor on residual renal function in patients receiving peritoneal dialysis a randomized controlled study
    Annals of Internal Medicine, 2003
    Co-Authors: Philip Kamtao Li, Kaiming Chow, Teresa Yukhwa Wong, Chibon Leung, Cheuk-chun Szeto

    Abstract:

    BACKGROUND: Residual renal function is an important determinant of mortality and morbidity in patients receiving peritoneal dialysis. However, few studies have evaluated therapeutic approaches for preserving residual renal function after the initiation of dialysis. OBJECTIVE: To test the hypothesis that the Angiotensin-Converting Enzyme (ACE) Inhibitor ramipril slows the decline in residual renal function in patients with end-stage renal failure treated with peritoneal dialysis. DESIGN: Randomized, open-label, controlled trial. SETTING: Single-center study in the dialysis unit of a university teaching hospital. PATIENTS: 60 patients receiving peritoneal dialysis. MEASUREMENTS: Patients were randomly assigned to ramipril (5 mg daily) or no treatment. The target blood pressure was 135/85 mm Hg or less. Rate of decline in residual glomerular filtration rate (GFR) and development of complete anuria were compared among groups. RESULTS: Over 12 months, average residual GFR declined by 2.07 mL/min per 1.73 m2 in the ramipril group versus 3.00 mL/min per 1.73 m2 in the control group (P = 0.03). The difference between the average changes in residual GFR in the ramipril and control groups from baseline to 12 months was 0.93 mL/min per 1.73 m2 (95% CI, 0.09 to 1.78 mL/min per 1.73 m2). At 12 months, 14 patients in the ramipril group and 22 in the control group developed anuria. With intention-to-treat multivariable analysis using the Cox model, it was estimated that at 3, 6, and 9 months, patients assigned to ramipril had a higher adjusted hazard of complete anuria than did patients assigned to no treatment. Of the 25 patients who still did not have complete anuria at 12 months, those assigned to ramipril had a better prognosis than did those assigned to no treatment (adjusted hazard ratio, 0.58 [CI, 0.36 to 0.94]). The rates of death from any cause, duration of hospitalization, and cardiovascular events did not differ significantly between groups. CONCLUSIONS: Although the trial was small and had a limited ability to exclude effects of potential confounding factors, the Angiotensin-Converting Enzyme Inhibitor ramipril may reduce the rate of decline of residual renal function in patients with end-stage renal failure treated with peritoneal dialysis.

Michael A Farber – 3rd expert on this subject based on the ideXlab platform

  • renal outcomes in high risk hypertensive patients treated with an angiotensin converting Enzyme Inhibitor or a calcium channel blocker vs a diuretic a report from the antihypertensive and lipid lowering treatment to prevent heart attack trial allhat
    JAMA Internal Medicine, 2005
    Co-Authors: Mahboob Rahman, Sara L Pressel, Barry R Davis, Chuke Nwachuku, Jackson T. Wright, Paul K Whelton, Joshua I Barzilay, Vecihi Batuman, John H. Eckfeldt, Michael A Farber

    Abstract:

    Background: This study was performed to determine whether, in high-risk hypertensive patients with a reduced glomerular filtration rate (GFR), treatment with a calcium channel blocker or an Angiotensin-Converting Enzyme Inhibitor lowers the incidence of renal disease outcomes compared with treatment with a diuretic. Methods: We conducted post hoc analyses of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertensive participants 55 years or older with at least 1 other coronary heart disease risk factor were randomized to receive chlorthalidone, amlodipine, or lisinopril for a mean of 4.9 years. Renal outcomes were incidence of end-stage renal disease (ESRD) and/or a decrement in GFR of 50% or more from baseline. Baseline GFR, estimated by the simplified Modification of Diet in Renal Disease equation, was stratified into normal or increased (90 mL /min per 1.73 m 2 , n=8126), mild reduction (60-89 mL/min per 1.73 m 2 , n=18 109), or moderate-severe reduction (60 mL/min per 1.73 m 2 , n=5662) in GFR. Each stratum was analyzed for effects of the treatments on outcomes. Results: In 448 participants, ESRD developed. Compared with patients taking chlorthalidone, no significant differences occurred in the incidence of ESRD in patients taking amlodipine in the mild (relative risk [RR], 1.47; 95% confidence interval [CI], 0.97-2.23) or moderate-severe (RR,0.92; 95% CI, 0.68-1.24) reduction in GFR groups. Compared with patients taking chlorthalidone, no significant differences occurred in the incidence of ESRD in patients taking lisinopril in the mild (RR, 1.34; 95% CI, 0.87-2.06) or moderate-severe (RR,0.98; 95% CI, 0.73-1.31) reduction in GFR groups. In patients with mild and moderate-severe reduction in GFR, the incidence of ESRD or 50% or greater decrement in GFR was not significantly different in patients treated with chlorthalidone compared with those treated with amlodipine (odds ratios, 0.96 [P = .74] and 0.85 [P=.23], respectively) and lisinopril (odds ratios, 1.13 [P=.31] and 1.00 [P=.98], respectively). No difference in treatment effects occurred for either end point for patients taking amlodipine or lisinopril compared with those taking chlorthalidone across the 3 GFR subgroups, either for the total group or for participants with diabetes at baseline. At 4 years of follow-up, estimated GFR was 3 to 6 mL/min per 1.73 m 2 higher in patients assigned to receive amlodipine compared with chlorthalidone, depending on baseline GFR stratum. Conclusions: In hypertensive patients with reduced GFR, neither amlodipine nor lisinopril was superior to chlorthalidone in reducing the rate of development of ESRD or a 50% or greater decrement in GFR. Participants assigned to receive amlodipine had a higher GFR than those assigned to receive chlorthalidone, but rates of development of ESRD were not different between the groups. Arch Intern Med. 2005;165:936-946

  • renal outcomes in high risk hypertensive patients treated with an angiotensin converting Enzyme Inhibitor or a calcium channel blocker vs a diuretic a report from the antihypertensive and lipid lowering treatment to prevent heart attack trial allhat
    JAMA Internal Medicine, 2005
    Co-Authors: Mahboob Rahman, Sara L Pressel, Barry R Davis, Chuke Nwachuku, Jackson T. Wright, Paul K Whelton, Joshua I Barzilay, Vecihi Batuman, John H. Eckfeldt, Michael A Farber

    Abstract:

    Background This study was performed to determine whether, in high-risk hypertensive patients with a reduced glomerular filtration rate (GFR), treatment with a calcium channel blocker or an Angiotensin-Converting Enzyme Inhibitor lowers the incidence of renal disease outcomes compared with treatment with a diuretic. Methods We conducted post hoc analyses of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertensive participants 55 years or older with at least 1 other coronary heart disease risk factor were randomized to receive chlorthalidone, amlodipine, or lisinopril for a mean of 4.9 years. Renal outcomes were incidence of end-stage renal disease (ESRD) and/or a decrement in GFR of 50% or more from baseline. Baseline GFR, estimated by the simplified Modification of Diet in Renal Disease equation, was stratified into normal or increased (≥90 mL /min per 1.73m 2 , n = 8126), mild reduction (60-89 mL /min per 1.73 m 2 , n = 18 109), or moderate-severe reduction ( 2 , n = 5662) in GFR. Each stratum was analyzed for effects of the treatments on outcomes. Results In 448 participants, ESRD developed. Compared with patients taking chlorthalidone, no significant differences occurred in the incidence of ESRD in patients taking amlodipine in the mild (relative risk [RR], 1.47; 95% confidence interval [CI], 0.97-2.23) or moderate-severe (RR, 0.92; 95% CI, 0.68-1.24) reduction in GFR groups. Compared with patients taking chlorthalidone, no significant differences occurred in the incidence of ESRD in patients taking lisinopril in the mild (RR, 1.34; 95% CI, 0.87-2.06) or moderate-severe (RR, 0.98; 95% CI, 0.73-1.31) reduction in GFR groups. In patients with mild and moderate-severe reduction in GFR, the incidence of ESRD or 50% or greater decrement in GFR was not significantly different in patients treated with chlorthalidone compared with those treated with amlodipine (odds ratios, 0.96 [ P  = .74] and 0.85 [ P  = .23], respectively) and lisinopril (odds ratios, 1.13 [ P  = .31] and 1.00 [ P  = .98], respectively). No difference in treatment effects occurred for either end point for patients taking amlodipine or lisinopril compared with those taking chlorthalidone across the 3 GFR subgroups, either for the total group or for participants with diabetes at baseline. At 4 years of follow-up, estimated GFR was 3 to 6 mL /min per 1.73 m 2 higher in patients assigned to receive amlodipine compared with chlorthalidone, depending on baseline GFR stratum. Conclusions In hypertensive patients with reduced GFR, neither amlodipine nor lisinopril was superior to chlorthalidone in reducing the rate of development of ESRD or a 50% or greater decrement in GFR. Participants assigned to receive amlodipine had a higher GFR than those assigned to receive chlorthalidone, but rates of development of ESRD were not different between the groups.