Related Experiment Video
Updated: Jun 26, 2025
08:35
Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
3.2K
Prescribing Trends of Renin-Angiotensin System Inhibitors and Mortality among Acute Coronary Syndrome Patients:
Siti Zaleha Suki1,2, Ahmad Syadi Mahmood Zuhdi3, Abqariyah Yahya4
1Department of Pharmacology, Faculty of Dentistry, Universiti Teknologi MARA, Selangor, Malaysia.
Saudi Journal of Medicine & Medical Sciences
|May 20, 2024
Summary
Despite guideline recommendations, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) prescription rates in acute coronary syndrome (ACS) patients declined over 10 years in Malaysia. However, ACEI/ARB use was associated with a 38% lower 1-year mortality rate.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Suboptimal prescription rates of ACEIs/ARBs are noted in acute coronary syndrome (ACS) patients, contrary to guidelines.
- This highlights a gap in evidence-based treatment adherence in cardiovascular care.
Purpose of the Study:
- To investigate the 10-year trends and variations in ACEI/ARB prescription among Malaysian ACS patients.
- To analyze the association between ACEI/ARB use and 1-year all-cause mortality in this population.
Main Methods:
- Retrospective analysis of 60,854 ACS patients from the Malaysian National Cardiovascular Disease-Acute Coronary Syndrome registry (2008-2017).
- Examination of temporal prescription trends and comparison of demographic/clinical characteristics and mortality outcomes between patients prescribed and not prescribed ACEIs/ARBs.
- Inverse Probability of Treatment Weighting (IPTW)-adjusted survival analysis was used to assess mortality.
Main Results:
- On-discharge ACEI/ARB prescription rates showed a significant decline over 10 years (52.8%), with lower rates in elderly patients (≥65 years), and those with diabetes mellitus (DM) or chronic kidney disease (CKD).
- Patients with comorbid DM and CKD were significantly less likely to receive ACEIs/ARBs.
- IPW-adjusted analysis revealed a 38% reduction in 1-year all-cause mortality for patients prescribed ACEIs/ARBs (HR=0.62, P<0.001).
Conclusions:
- Suboptimal ACEI/ARB prescription rates persist in Malaysian ACS patients, particularly those with DM and CKD.
- Despite declining trends, ACEI/ARB use is associated with significantly improved 1-year survival in ACS patients.
Related Concept Videos
01:25Antihypertensive Drugs: Direct Renin Inhibitors
597
The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
597
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
421
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
421
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
618
Angiotensin-converting enzyme (ACE), a vital component of the renin-angiotensin-aldosterone system, is abundant in lung endothelial cells. ACE converts the inactive decapeptide, angiotensin I, into the active octapeptide, angiotensin II. This potent vasoconstrictor narrows blood vessels, increasing resistance to blood flow and elevating blood pressure. Angiotensin II also stimulates aldosterone production, encouraging kidney cells to reabsorb more sodium and water from urine, thereby increasing...
618
01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers
714
In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
714
01:22Heart Failure Drugs: Diuretics
363
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
363
01:33Hormonal Regulation
33.1K
The renin-aldosterone system is an endocrine system which guides the renal absorption of water and electrolytes, thus managing blood pressure and osmoregulation. Activation of the system begins in the kidneys with a small cluster of cells adjacent to the afferent and efferent blood vessels of the renal corpuscle. As the nephrons are filtering blood, juxtaglomerular cells monitor blood pressure. If they detect a decrease in pressure, they release the hormone renin into the bloodstream.
33.1K