title: Discontinuation/Dose Reduction of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers during Acute Decompensated Heart Failure in African-American Patients with Reduced Left-Ventricular Ejection Fraction.
abstract: OBJECTIVE
  Patients with heart failure (HF) and reduced left-ventricular ejection fraction (LVEF) benefit from angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blocker (ARB) therapy. While dose reduction/discontinuation (r/d) of β-blockers (BB) and furosemide in acute decompensated HF (ADHF) worsen outcomes, data on ACEI/ARB are lacking.
  
  
  METHODS
  To determine the frequency and reasons for ACEI/ARB therapy r/d in ADHF patients, we studied 174 patients with LVEF <40% on ACEI/ARB and BB therapy upon admission over 1 year.
  
  
  RESULTS
  ACEI/ARB doses were r/d in 17.2% because of acute kidney injury (56.7%), hypotension (23.3%), and hyperkalemia (10%). Clinical characteristics were similar between patients with r/d and continued therapy. Admission and discharge creatinine (Cr) levels were higher in the r/d group. On multivariate analysis, admission Cr and admission systolic blood pressures were independent predictors of r/d. Among patients with renal dysfunction cited as the r/d reason, Cr did not significantly rise in 23.5%. The r/d group had a longer length of stay (LOS).
  
  
  CONCLUSIONS
  ACEI/ARB dose is reduced and/or discontinued in nearly one-fifth of all ADHF admissions, and LOS is longer in the ACEI/ARB r/d group. While impaired renal function is the most frequently cited reason, nearly one-fourth of the patients had stable renal function. ACEI/ARB r/d therapy in the setting of ADHF merits further study.
authors.affiliation: Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Kane
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Kim
authors.forename: Syed Abbas
authors.initials: SA
authors.lastname: Haidry
authors.forename: Louis
authors.initials: L
authors.lastname: Salciccioli
authors.forename: Jason
authors.initials: J
authors.lastname: Lazar
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D001741:Black or African American; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006947:Hyperkalemia / Q000150:complications; D007022:Hypotension / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D014481:United States; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D003404:Creatinine
keywords: Angiotensin receptor blockers; Angiotensin-converting enzyme inhibitors; Congestive heart failure