scholarly journals Lack of Association Between Neurohormonal Blockade and Survival in Transthyretin Cardiac Amyloidosis

2021 ◽  
Author(s):  
Richard K. Cheng ◽  
Alexi Vasbinder ◽  
Wayne C. Levy ◽  
Parag Goyal ◽  
Jan M. Griffin ◽  
...  
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Cardiac Amyloidosis ◽  
Angiotensin Receptor Blocker ◽  
Enzyme Inhibitor ◽  
Time Varying ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Inverse Probability ◽  
Total Cohort ◽  
Mineralocorticoid Antagonist

Background Despite the belief that heart failure therapies are not effective in transthyretin cardiac amyloidosis, data are limited. We tested the association of neurohormonal blockade use with survival. Methods and Results A total of 309 consecutive patients with transthyretin cardiac amyloidosis were identified. Medication inventory was obtained at baseline and subsequent visits. Exposure included a neurohormonal blockade class (β‐blocker [βB], angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker, and mineralocorticoid antagonist) at baseline and subsequent visits. βB was modeled as baseline use, time‐varying use, and in an inverse probability treatment weighted model. Primary outcome was all‐cause mortality analyzed with adjusted Cox proportional hazards models. Continuing compared with stopping βB during follow‐up was tested. Mean age was 73.2 years, 84.1% were men, and 17.2% had atrial fibrillation/flutter at baseline. At the time of study entry, 49.8% were on βBs, 35.0% were on angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, and 23.9% were on mineralocorticoid antagonists. For the total cohort, there was a trend toward harm in the unadjusted model for baseline βB use, but this was neutral after adjustment. When βB use was analyzed as a time‐varying exposure, there was no association with mortality. βB discontinuation was associated with decreased mortality for the total cohort. Findings were consistent in inverse probability treatment weighted models. For angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker or mineralocorticoid antagonist use, there was no association with mortality after adjustment for the total cohort. Conclusions There was no association of neurohormonal blockade use with survival in transthyretin cardiac amyloidosis. For the total cohort, deprescribing βB may be associated with improved survival. Additional studies are needed to confirm these findings.

scholarly journals Effect of Dual Blockade of Renin-Angiotensin System on Proteinuria

2013 ◽  
Vol 1 (1) ◽  
pp. 18-20
Author(s):  
Eqerem Hasani ◽  
Alma Idrizi ◽  
Myftar Barbullushi
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Angiotensin Receptor Blocker ◽  
Enzyme Inhibitor ◽  
Combined Therapy ◽  
Renin Angiotensin System ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Dual Blockade

Aim: Aim of the study was the evaluation of the effect of dual blockade of the renin-angiotensin system (RAS) on proteinuria. Material and Methods: Sixty patients, included in the study, were treated with angiotensin-converting enzyme inhibitor and angiotensin receptor blocker for a period of 3 months. Results: The dual blockade of RAS resulted with decrease of proteinuria, a slight increase of serum creatinine and was not associated with a lowering of blood pressure.Conclusion: Combined therapy with ACE-I and ARB results in a more complete blockade of the RAS than monotherapy. In proteinuric nephropathies it reduces significantly baseline proteinuria.

scholarly journals The Effect of Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker on the Outcome of Hospitalization of Patients With Hypertension and COVID-19

2021 ◽  
Vol 34 (6) ◽  
pp. 665-666
Author(s):  
Xi-jing Zhuang ◽  
Wen-jun Wang ◽  
Xiao-hui Zhao ◽  
Wei Wei ◽  
Wei-wang Fan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Creatine Kinase ◽  
Angiotensin Converting Enzyme ◽  
Angiotensin Converting Enzyme Inhibitor ◽  
Angiotensin Receptor Blocker ◽  
Enzyme Inhibitor ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitor ◽  
Group A

Abstract Background To study the effect of angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) on the outcome of hospitalization in patients with hypertension and novel coronavirus disease 2019 (COVID-19). Methods A retrospective analysis was performed in 202 COVID-19 patients who were hospitalized in Thunder-God Hospital, Wuhan from 12 February 2020 to 30 March 2020. According to whether taking ACEI or ARB, 67 (33.0%) patients with hypertension were divided into 3 groups: A, patients received ACEI or ARB after admission (n = 22); B, patients received ACEI or ARB before admission but interrupted after admission (n = 24); and C, patients were not treated with ACEI or ARB before or after admission (n = 21). Changes of therapeutic indicators in all groups of patients and their application relationship with ACEI/ARB were compared and analyzed. Results There were no significant differences in age, gender, blood pressure, underlying disease severity, or serum biochemical indicators (ALT, LDH, creatinine, and creatine kinase levels) at admission among 3 groups (all P > 0.05). During hospitalization, there were no significant differences in COVID-19-related treatment, oxygen use, hospital mortality, recovery and discharge rate, or days of throat swab nucleic acid turning negative among 3 groups (all P > 0.05). The proportion of calcium channel blocker in groups B and C was higher than group A (95.8% and 85.7% vs. 40.9%, P < 0.01), but there was no significant difference in blood pressure or compliance rates at discharge (P > 0.05). Group A, B, and C patients were hospitalized for 27.4 ± 6.4, 30.0 ± 8.8, and 30.1 ± 9.3 days, respectively (all P > 0.05). Compared with admission values, there were no significant differences in serum ALT, LDH, creatinine, or creatine kinase levels among all 3 groups during hospitalization (all P > 0.05). Conclusions ACEI or ARB has no significant effect on the outcome of hospitalization in patients with hypertension and COVID-19.

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