title: The Association of Losartan and Ramipril Therapy With Kidney and Cardiovascular Outcomes in Patients With Chronic Kidney Disease: A Chinese Nation-Wide Cohort Study in Taiwan.
abstract: The aim of this nation-wide cohort study was to assess the association of using an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB) therapy on the prognosis of hypertensive patients with chronic kidney disease (CKD). We used Cox's proportional hazard regression model to estimate hazard ratios (HRs) for the risk of end-stage renal disease (ESRD), all-cause mortality, cardiovascular mortality, and first hospitalization for cardiovascular disease (CVD) for losartan and ramipril versus conventional antihypertensive agents. In total, 136,266 hypertensive patients with CKD in Taiwan were followed up from 2001 to 2008. In an average follow-up of 5.9 years, 7364 (5.40%) patients reached ESRD, 4165 (3.06%) patients died, and 6163 (4.52%) patients had their first hospitalization for CVD. Use of losartan or ramipril was associated with a lower risk of the endpoints compared with the conventional group. In the losartan group, the risks of ESRD, all- and cardiovascular-cause mortality, and first hospitalization for CVD were decreased by 9.2% (P = 0.01), 24.6% (P < 0.001), 12.4% (P = 0.03), and 36.0% (P = 0.01), respectively. In the ramipril group, these risks decreased by 7.6% (P = 0.02) for ESRD, 56.9% (P < 0.001) for all-cause mortality, 7.5% (P = 0.04) for cardiovascular mortality, and 24.7% (P < 0.001) for first hospitalization. This study indicated that losartan and ramipril had distinct association on the prognosis of hypertensive patients with CKD, and was first to disclose that the mean time to reach each endpoint for patients in the losartan, ramipril, and conventional group was not significantly different. However, further study is needed to confirm results of the present study.
authors.affiliation: From the Graduate Institute of Life Sciences (S-CH, S-YK) and School of Public Health (W-CC, C-HC, S-YK), National Defense Medical Center, Neihu District, Taipei City, Taiwan; Center of Medical Quality Management, Cheng Hsin General Hospital, Beitou District, Taipei City, Taiwan (S-CH); Department of Nephrology, Cardinal Tien Hospital, Xindian District, New Taipei City, Taiwan (K-CL); and Department of Public Health, College of Medicine, Fu-Jen Catholic University, Xinzhuang District, New Taipei City, Taiwan (C-AS).
authors.forename: Shih-Chun
authors.initials: SC
authors.lastname: Hsing
authors.forename: Kuo-Cheng
authors.initials: KC
authors.lastname: Lu
authors.forename: Chien-An
authors.initials: CA
authors.lastname: Sun
authors.forename: Wu-Chien
authors.initials: WC
authors.lastname: Chien
authors.forename: Chi-Hsiang
authors.initials: CH
authors.lastname: Chung
authors.forename: Sen-Yeong
authors.initials: SY
authors.lastname: Kao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D019808:Losartan; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017257:Ramipril; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000401:mortality; D013624:Taiwan; D055815:Young Adult
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D019808:Losartan; D017257:Ramipril