title: Effect of Renin-Angiotensin system inhibition on cardiovascular events in older hypertensive patients with metabolic syndrome.
abstract: OBJECTIVE
  Metabolic syndrome (MetS) is associated with cardiovascular disease (CVD). Insulin resistance has been hypothesized as the underlying feature of MetS. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are widely used antihypertensives that may improve insulin sensitivity. The aim of the study is to evaluate the effect of ACEI/ARB on incident CVD events in older hypertensive patients with MetS.
  
  
  METHODS
  We used the Cardiovascular Health Study, a prospective cohort study of individuals>65years of age to evaluate ACEI/ARB use and time to CVD events (including coronary and cerebrovascular events). The study included 777 subjects who had hypertension and ATP III-defined MetS, but free of CVD and diabetes at baseline. Cox regression models were used to evaluate the effect of ACEI/ARB as compared to other antihypertensives on the time to the first CVD events.
  
  
  RESULTS
  ACEI/ARB use was associated with a decreased risk of CVD events (adjusted HR=0.658, 95 % C.I. [0.436-0.993]) compared to other antihypertensives. When CVD endpoints were evaluated separately, use of ACEI/ARB was associated with lower rates of angioplasty and coronary events (HR of 0.129 and 0.530 respectively, with 95 % CI [0.017-0.952] and [0.321-0.875]).
  
  
  CONCLUSIONS
  ACEI/ARB use was associated with a lower risk of CVD events in older hypertensive patients with MetS, primarily due to a reduction in coronary events. The potential protective effect of ACEI/ARB on CVD events in older individuals with MetS will need further confirmation from prospective studies.
authors.affiliation: Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Hala H
authors.initials: HH
authors.lastname: Zreikat
authors.affiliation: Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Spencer E
authors.initials: SE
authors.lastname: Harpe
authors.affiliation: Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Slattum
authors.affiliation: Department of Statistical Sciences and Operations Research, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: D'arcy P
authors.initials: DP
authors.lastname: Mays
authors.affiliation: Department of Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Paulina A
authors.initials: PA
authors.lastname: Essah
authors.affiliation: Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: kicheang@vcu.edu.
authors.forename: Kai I
authors.initials: KI
authors.lastname: Cheang
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D024821:Metabolic Syndrome / Q000188:drug therapy*; D011446:Prospective Studies; D012084:Renin-Angiotensin System / Q000187:drug effects*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents
keywords: Angiotensin converting enzyme inhibitor; Angiotensin receptor blocker; Insulin resistance