2-1EFFECTIVENESS OF ACEI/ARB MONOTHERAPY ON SURVIVAL OUTCOMES IN PATIENTS WITH HYPERTENSIVE CHRONIC KIDNEY DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF LARGE COHORT STUDIES. (July 2020)

• Record Type: Journal Article
• Authors: Laurentius, Andrea; Ivan, Ignatius
• Is Part Of: Journal of hypertension. Volume 38(2020)Supplement 1
• Publication Date: 2020-07
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000689108.95300.49
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : N/A: Cardiovascular morbidity is a significant promoter of 50% overall mortality in renal hypertensive patients. Based on Joint National Committee 8 Guideline, treatment of hypertensive chronic kidney disease (CKD) using angiotensin receptor blockers (ARB) or angiotensin-converting enzyme inhibitor (ACEi) are suggested as they pharmacodynamically block the action of angiotensin II. To address the problem related to inconsistent therapeutic benefits of renin-angiotensin-aldosterone system (RAAS) blockers, head-to-head systematic review and meta-analysis of cohort studies examining pharmacological benefits of ARB/ACEi monotherapy toward the prognosis of major cardiovascular event (MACE) and all-deaths in hypertensive CKD patients were conducted. Database access was obtained through login into remote library, and terms of medical references refined advanced keywords searching. Seven out of 714 studies were systematically assessed from total of five databases using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tool deliver quality of studies. Several studies had shown therapeutic benefits of ACEi/ARB in improving cardiovascular prognosis of hypertensive CKD patients. Based on quantitative analysis of a five-year follow-up, we found 31% higher survival rate for patients who received ACE-I/ARB monotherapy compared to non-users via random effect estimation. Furthermore, seven studies suggested similar outcomes favoring ACEi/ARB for long-term survival benefit against all-cause mortality. This could be biologically explained through the mechanism of RAAS blockers in preventing cardiac remodeling. Thus, further studies toward ACEi/ARB monotherapy in preventing MACE and deaths of hypertensive CKD patients are recommended to support the conclusion.