Early and late effects of high- versus low-dose angiotensin receptor blockade on renal function and outcomes in patients with chronic heart failure

JACC. Heart Failure
M KiernanMarvin A Konstam

Abstract

This study investigated the dose-related effect of losartan on changes in renal function using data from the HEAAL (Heart failure Endpoint evaluation of Angiotensin II Antagonist Losartan) trial. Angiotensin receptor blockers adversely affect renal function in patients with heart failure (HF). The time course and dose dependency of this time course, as well as the clinical implications of these changes in renal function, are not well described. Subjects in the HEAAL dataset (n = 3,843) were studied. Changes in estimated glomerular filtration rate (eGFR) over time were compared between dose groups. The association between the timing of incident increases in serum creatinine (SCr) >0.3 mg/dl and clinical outcomes was explored. Compared with 50 mg, 150 mg losartan led to a greater reduction in eGFR across time (mean difference: -3.79 ml/min/1.73 m(2); p < 0.0001). This difference was driven by early changes, and differences in eGFR after 4 months were not significant (mean difference: 0.40 ml/min/1.73 m(2); p = 0.16). Although an increase in SCr >0.3 mg/dl from baseline was associated with increased risk of death or hospitalization for HF (hazard ratio [HR]: 1.36; p < 0.0001), the relationship was not significant if the change occ...Continue Reading

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Citations

Feb 28, 2020·The Cochrane Database of Systematic Reviews·Meaghan LunneyPietro Ravani
Sep 14, 2017·British Journal of Clinical Pharmacology·Ahmed Al-NaherMunir Pirmohamed
Jan 7, 2017·Current Opinion in Cardiology·Feras M Bader, Nizar Attallah
Jul 22, 2019·Journal of the American Society of Nephrology : JASN·Srinivasan BeddhuTom Greene

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