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Renal function and effectiveness of angiotensin-converting enzyme inhibitor therapy in patients with chronic stable
Scott D Solomon1, Madeline M Rice, Kathleen A Jablonski
1Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, Massachusetts 02115, USA. ssolomon@rics.bwh.harvard.edu
Circulation
|June 28, 2006
Summary
Patients with reduced renal function may benefit more from angiotensin-converting enzyme (ACE) inhibitor therapy. Trandolapril reduced mortality in those with reduced kidney function, suggesting a specific patient group for cardiovascular protection.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Patients with reduced renal function face higher cardiovascular risks.
- Angiotensin-converting enzyme (ACE) inhibitors are effective post-myocardial infarction, regardless of renal function.
- The PEACE trial investigated ACE inhibitor effectiveness in stable coronary artery disease.
Purpose of the Study:
- To assess the relationship between renal function and cardiovascular outcomes.
- To evaluate the influence of ACE inhibition on this relationship.
- To determine if renal function modifies ACE inhibitor effectiveness.
Main Methods:
- The Prevention of Events with ACE inhibition (PEACE) trial randomized 8290 patients to trandolapril or placebo.
- Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease equation.
- Interaction modeling assessed the relationship between eGFR, treatment, and outcomes.
Main Results:
- 16.3% of patients had reduced renal function (eGFR <60).
- A significant interaction was observed between eGFR and treatment on mortality (P=0.02).
- Trandolapril reduced total mortality in patients with reduced renal function (HR, 0.73) but not in those with preserved function (HR, 0.94).
Conclusions:
- Trandolapril did not improve survival in the overall PEACE cohort with high mean eGFR.
- Trandolapril reduced mortality specifically in patients with reduced eGFR.
- Reduced renal function may identify patients most likely to benefit from ACE inhibitors for cardiovascular protection.
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