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Reviving Decades-Old Wisdom: Longitudinal Analysis of Renin-Angiotensin System Inhibitors and Its Effects on Acute
Sophie Samuel1, Kyndol Craver1, Charles Miller2
1Department of Pharmacy, Memorial Hermann Hospital, Houston, Texas, USA.
Background:
While renin-angiotensin system (RAS) inhibitors have a longstanding history in blood pressure control, their suitability as first-line in-patient treatment may be limited due to prolonged half-life and kidney failure concerns.
Methods:
Using a cohort design, we assessed the impact of RAS inhibitors, either alone or in combination with beta-blockers, on mortality, while exploring interactions, including those related to end-stage renal disease and serum creatinine levels. Eligible subjects were Acute Ischemic Stroke (AIS) patients aged 18 or older with specific subtypes who received in-patient antihypertensive treatment. The primary outcome was mortality rates. Statistical analyses included cross-sectional and longitudinal approaches, employing generalized linear models, G-computation, and discrete-time survival analysis over a 20-day follow-up period.
Results:
In our study of 3,058 AIS patients, those using RAS inhibitors had significantly lower in-hospital mortality (2.2%) compared to non-users (12.1%), resulting in a relative risk (RR) of 0.18 (95% CI: 0.12-0.26). Further analysis using G-computation revealed a marked reduction in mortality risk associated with RAS inhibitors (0.0281 vs. 0.0913, risk difference [RD] of 6.31% or 0.0631, 95% CI: 0.046-0.079). Subgroup analysis demonstrated notable benefits, with individuals having creatinine levels below and above 1.3 mg/dl exhibiting statistically significant RD (RD -0.0510 vs. -0.0895), and a significant difference in paired comparison (-0.0385 or 3.85%, CI 0.023-0.054). Additionally, longitudinal analysis confirmed a consistent daily reduction of 0.93% in mortality risk associated with the intake of RAS inhibitors.
Conclusions:
RAS inhibitors are associated with a significant reduction in in-hospital mortality in AIS patients, suggesting potential clinical benefits in improving patient outcomes.
Insights
Renin-angiotensin system (RAS) inhibitors significantly reduced in-hospital mortality in acute ischemic stroke (AIS) patients. These findings suggest RAS inhibitors offer clinical benefits for improving outcomes in AIS patients.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Renin-angiotensin system (RAS) inhibitors are established antihypertensives.
- Concerns exist regarding their use as first-line treatments due to long half-lives and kidney function implications.
Purpose of the Study:
- To evaluate the impact of RAS inhibitors on mortality in acute ischemic stroke (AIS) patients.
- To explore interactions of RAS inhibitors with beta-blockers, end-stage renal disease, and creatinine levels on mortality.
Main Methods:
- A cohort study design was employed with 3,058 AIS patients receiving in-patient antihypertensive treatment.
- Statistical analyses included generalized linear models, G-computation, and discrete-time survival analysis over 20 days.
- Outcomes assessed included mortality rates, with subgroup analyses based on creatinine levels.
Main Results:
- RAS inhibitors were associated with significantly lower in-hospital mortality (2.2% vs. 12.1%) compared to non-users (Relative Risk=0.18).
- G-computation showed a marked reduction in mortality risk (Risk Difference=6.31%).
- Subgroup analyses and longitudinal data confirmed consistent mortality risk reduction with RAS inhibitor use.
Conclusions:
- RAS inhibitors demonstrate a significant association with reduced in-hospital mortality in AIS patients.
- These findings support the potential clinical utility of RAS inhibitors in improving outcomes for AIS patients.
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