Abstract 11598: Determinants of Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker Use in Patients With Atherosclerotic Renal Artery Stenosis and Effects on Blood Pressure
Introduction: Atherosclerotic renal artery stenosis (ARAS) patients may benefit from angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) but little is known about the factors influencing this prescribing decision.
Hypothesis: Patient characteristics and study site predict ACEI/ARB use in ARAS.
Methods: The Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) clinical trial is a prospective, international, multi-center trial. Baseline data, including medication logs, was obtained from 923 randomized patients. Renal function was measured at the site and core lab. Sites were categorized as low, intermediate and high use for ACEI/ARB (<25, 25-75, >75%).
Results: Prior to randomization, ACEIs/ARBs were used in 419 (45%) patients. Use was negatively influenced by the presence of renal dysfunction (23% vs. 30%, p=0.03), positively by diabetes (41% vs. 27%, p<0.001) but was not influenced by bilateral RAS (p=0.41). ACEI/ARB use was associated with an increase in the total number of non-ACEI/ARB anti-hypertensives (2.0 vs. 1.3, p<0.001), and anti-platelets (75% vs. 62%, p=0.001). Patients enrolled at low, intermediate and high ACEI/ARB sites were not different in any baseline characteristic. Patients on an ACEI/ARB had lower systolic blood pressure (148 vs. 152 mmHg, p=0.003) and were more frequently at BP goal (30% vs. 22%, p=0.015).
Conclusions: Renal dysfunction and diabetes, not bilateral RAS, influence ACEI/ARB use. Substantial heterogeneity exists between sites and is not explained by baseline patient characteristics. Despite this, patients on ACEI/ARB have lower BP and are more likely to be at BP goal.
- © 2013 by American Heart Association, Inc.