title: The impact of renin-angiotensin-aldosterone system blockade on heart failure outcomes and mortality in patients identified to have aortic regurgitation: a large population cohort study.
abstract: OBJECTIVE
  The aim of this study was to investigate the effect of renin-angiotensin system blockade on outcomes in patients with aortic regurgitation (AR).
  
  
  BACKGROUND
  Angiotensin-converting enzyme (ACE) inhibitors have the potential to reduce afterload, blunt left ventricular wall stress, and limit left ventricular dilation and hypertrophy. However, long-term studies have yielded inconsistent results, and very few have assessed clinical outcomes.
  
  
  METHODS
  The Health Informatics Centre dispensed prescription and morbidity and mortality database for the population of Tayside, Scotland, was linked through a unique patient identifier to the Tayside echocardiography database. Patients diagnosed with at least moderate AR from 1993 to 2008 were identified. Cox regression analysis was used to assess differences in all-cause mortality and cardiovascular (CV) and AR events (heart failure hospitalizations, heart failure deaths, or aortic valve replacement) between those treated with and without ACE inhibitors or angiotensin receptor blockers (ARBs).
  
  
  RESULTS
  A total of 2,266 subjects with AR (median age 74 years; interquartile range: 64 to 81 years) were studied, with a mean follow-up period of 4.4 ± 3.7 years. Seven hundred and five patients (31%) received ACE inhibitor or ARB therapy. There were 582 all-cause deaths (25.7%). Patients treated with ACE inhibitors or ARBs had significantly lower all-cause mortality and fewer CV and AR events, with adjusted hazard ratios of 0.56 (95% confidence interval [CI]: 0.64 to 0.89; p < 0.01) for all-cause mortality, 0.77 (95% CI: 0.67 to 0.89; p < 0.01) for CV events, and 0.68 (95% CI: 0.54 to 0.87; p < 0.01) for AR events.
  
  
  CONCLUSIONS
  This large retrospective study shows that the prescription of ACE inhibitors or ARBs in patients with moderate to severe AR was associated with significantly reduced all-cause mortality and CV and AR events. These data need to be confirmed by a prospective randomized controlled outcome trial.
authors: Centre for Cardiovascular and Lung Biology, Ninewells Hospital and Medical School, Dundee, United Kingdom.
authors: Douglas H J
authors: DH
authors: Elder
authors: Li
authors: L
authors: Wei
authors: Benjamin R
authors: BR
authors: Szwejkowski
authors: Renata
authors: R
authors: Libianto
authors: Adnan
authors: A
authors: Nadir
authors: Maheshwar
authors: M
authors: Pauriah
authors: Sushma
authors: S
authors: Rekhraj
authors: Tiong K
authors: TK
authors: Lim
authors: Jacob
authors: J
authors: George
authors: Alex
authors: A
authors: Doney
authors: Stuart D
authors: SD
authors: Pringle
authors: Anna-Maria
authors: AM
authors: Choy
authors: Allan D
authors: AD
authors: Struthers
authors: Chim C
authors: CC
authors: Lang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors