title: Comparative Effectiveness of Renin-Angiotensin System Antagonists in Maintenance Dialysis Patients.
abstract: OBJECTIVE
  Whether angiotensin converting enzyme inhibitors (ACE) and angiotensin receptor blockers (ARB) are differentially associated with reductions in cardiovascular events and mortality in patients receiving maintenance dialysis is uncertain. We compared outcomes between ACE and ARB users among hypertensive, maintenance dialysis patients.
  
  
  METHODS
  National retrospective cohort study of hypertensive, Medicare-Medicaid eligible patients initiating chronic dialysis between 1/1/2000 to 12/31/2005. The exposure of interest was new use of either an ACEI or ARB. Outcomes were all-cause mortality (ACM) and combined cardiovascular hospitalization or death (CV-endpoint). Cox proportion hazards models were used to compare the effect of ACEI vs ARB use on ACM and, separately, CV-endpoint.
  
  
  RESULTS
  ACM models were based on 3,555 ACEI and 1,442 ARB new users, while CV-endpoint models included 3,289 ACEI and 1,346 ARB new users. After statistical adjustments, ACEI users had higher hazard ratios for ACM (AHR = 1.22, 99% CI 1.05-1.42) and CV-endpoint (AHR = 1.12, 99% CI 0.99-1.27).
  
  
  CONCLUSIONS
  Patients initiating maintenance dialysis who received an ACEI faced an increased risk for mortality and a trend towards an increased risk for CV-endpoints when compared to patients who received an ARB. Validation of these results in a rigorous clinical trial is warranted.
authors.affiliation: Center for Gerontology &amp; Health Care Research, Department of Health Services, Policy &amp; Practice, Brown University School of Public Health, Providence, RI, USA.
authors.forename: Theresa I
authors.initials: TI
authors.lastname: Shireman
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Mahnken
authors.forename: Milind A
authors.initials: MA
authors.lastname: Phadnis
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
authors.forename: James B
authors.initials: JB
authors.lastname: Wetmore
mesh_terms: D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000401:mortality*; D012084:Renin-Angiotensin System / Q000187:drug effects; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors