Cardiovascular and renal protective role of angiotensin blockade in hypertension with advanced CKD: a subgroup analysis of ATTEMPT-CVD randomized trial

Sci Rep. 2018 Feb 16;8(1):3150. doi: 10.1038/s41598-018-20874-4.

Abstract

The ATTEMPT-CVD study was prospective randomized active-controlled trial and the main findings had been reported. According to baseline GFR and albuminuria categories, we divided the patients of the ATTEMPT-CVD study into 2 subgroups: (Group 1) the patients with at least one of eGFR of <45 ml/min per 1.73 m2 and UACR of ≥300 mg/g creatinine, defined as G3b and/or A3; (Group 2) the patients except for Group 1, defined as the other patients. In patients with G3b and/or A3, the incidence of cardiovascular events was significantly less in ARB group than in non-ARB group (11 vs 22, respectively) (HR = 0.465: 95%CI = 0.224-0.965; P = 0.040). UACR was significantly less in ARB group than in non-ARB group during follow-up period in patients with G3b and/or A3 (P = 0.0003), while eGFR, plasma BNP levels, and blood pressure were comparable between ARB and non-ARB groups. Allocation to ARB therapy was a significant independent prognostic factor for cardiovascular events in patients with G3b and/or A3 (P = 0.0268). On the other hand, in the other patients, the occurrence of cardiovascular events was comparable between ARB and non-ARB groups. In patients with advanced CKD, ARB-based therapy may confer greater benefit in prevention of cardiovascular events than non-ARB therapy.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angiotensin Receptor Antagonists / pharmacology*
  • Angiotensin Receptor Antagonists / therapeutic use
  • Blood Pressure / drug effects
  • Cardiovascular System / drug effects*
  • Cardiovascular System / physiopathology
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate / drug effects
  • Humans
  • Hypertension / complications*
  • Hypertension / drug therapy*
  • Hypertension / pathology
  • Hypertension / physiopathology
  • Kidney / drug effects*
  • Kidney / physiopathology
  • Male
  • Prognosis
  • Receptors, Angiotensin / metabolism*
  • Renal Insufficiency, Chronic / complications*

Substances

  • Angiotensin Receptor Antagonists
  • Receptors, Angiotensin