title: Renin-angiotensin inhibition in diastolic heart failure and chronic kidney disease.
abstract: BACKGROUND
  The role of renin-angiotensin inhibition in older patients with diastolic heart failure and chronic kidney disease remains unclear.
  
  
  METHODS
  Of the 1340 patients (age ≥65 years) with diastolic heart failure (ejection fraction ≥45%) and chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m(2)), 717 received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Propensity scores for the use of these drugs, estimated for each of the 1340 patients, were used to assemble a cohort of 421 pairs of patients, receiving and not receiving these drugs, who were balanced on 56 baseline characteristics.
  
  
  RESULTS
  During more than 8 years of follow-up, all-cause mortality occurred in 63% and 69% of matched patients with chronic kidney disease receiving and not receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, respectively (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.70-0.97; P = .021). There was no association with heart failure hospitalization (HR, 0.98; 95% CI, 0.82-1.18; P = .816). Similar mortality reduction (HR, 0.81; 95% CI, 0.66-0.995; P = .045) occurred in a subgroup of matched patients with an estimated glomerular filtration rate less than 45 mL/min/1.73 m(2). Among 207 pairs of propensity-matched patients without chronic kidney disease, the use of these drugs was not associated with mortality (HR, 1.03; 95% CI, 0.80-1.33; P = .826) or heart failure hospitalization (HR, 0.99; 95% CI, 0.76-1.30; P = .946).
  
  
  CONCLUSIONS
  A discharge prescription for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant reduction in all-cause mortality in older patients with diastolic heart failure and chronic kidney disease, including those with more advanced chronic kidney disease.
authors: University of Alabama at Birmingham, Birmingham, AL, USA. aahmed@uab.edu
authors: Ali
authors: A
authors: Ahmed
authors: Michael W
authors: MW
authors: Rich
authors: Michael
authors: M
authors: Zile
authors: Paul W
authors: PW
authors: Sanders
authors: Kanan
authors: K
authors: Patel
authors: Yan
authors: Y
authors: Zhang
authors: Inmaculada B
authors: IB
authors: Aban
authors: Thomas E
authors: TE
authors: Love
authors: Gregg C
authors: GC
authors: Fonarow
authors: Wilbert S
authors: WS
authors: Aronow
authors: Richard M
authors: RM
authors: Allman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D054144:Heart Failure, Diastolic / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D012084:Renin-Angiotensin System / Q000187:drug effects*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors