title: Angiotensin inhibition in renovascular disease: a population-based cohort study.
abstract: BACKGROUND
  Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers effectively reduce blood pressure in patients with renovascular disease (RVD); yet, randomized cardiovascular prevention trials of these drugs typically exclude individuals with this condition.
  
  
  METHODS
  We studied the association of renin-angiotensin system inhibition with prognosis in a population-based cohort comprising 3,570 patients with RVD in Ontario, Canada; slightly more than half (n = 1,857, 53%) were prescribed angiotensin inhibitors. The primary outcome was the composite of death, myocardial infarction, or stroke. Secondary outcomes included individual cardiovascular and renal events.
  
  
  RESULTS
  Patients receiving angiotensin inhibitors had a significantly lower risk for the primary outcome during follow-up (10.0 vs 13.0 events per 100 patient-years at risk, multivariable adjusted hazard ratio [HR] 0.70, 95% CI 0.59-0.82). In addition, hospitalization for congestive heart failure (HR 0.69, 95% CI 0.53-0.90), chronic dialysis initiation (HR 0.62, 95% CI 0.42-0.92), and mortality (HR 0.56, 95% CI 0.47-0.68) was lower in treated patients. Conversely, patients receiving angiotensin inhibitors were significantly more likely to be hospitalized for acute renal failure during follow-up (HR 1.87, 95% CI 1.05-3.33; 1.2 vs 0.6 events per 100 patient-years at risk).
  
  
  CONCLUSIONS
  These data emphasize the high vascular risk of RVD and suggest that angiotensin inhibitors may improve prognosis in this setting at the expense of acute renal toxicity. If the latter are selected in the management of RVD, renal function parameters should be assiduously followed.
authors.affiliation: Division of Clinical Pharmacology, University of Western Ontario, London, Ontario, Canada. dhackam@uwo.ca
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Hackam
authors.forename: Minh L
authors.initials: ML
authors.lastname: Duong-Hua
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.forename: Sheldon W
authors.initials: SW
authors.lastname: Tobe
authors.forename: J David
authors.initials: JD
authors.lastname: Spence
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg