Electrolyte Blood Press.  2019 Dec;17(2):25-35. 10.5049/EBP.2019.17.2.25.

Effect of Renin-Angiotensin System Blockade on Mortality in Korean Hypertensive Patients with Proteinuria

• Oh HJ
• Kim CT
• Ryu DR

• KMID: 2467958
• DOI: http://doi.org/10.5049/EBP.2019.17.2.25

Abstract

BACKGROUND
Although renin-angiotensin system (RAS) blockade is recommended for hypertensive patients with proteinuria, the effect of RAS blockade on Korean hypertensive patients has not been investigated.
METHODS
Among individuals who underwent a National Health Examination between 2002 and 2003 in Korea, hypertensive patients with proteinuria (defined as a dipstick test result ≥2+) were enrolled in this study. We investigated the outcomes of two groups stratified by RAS blockade prescription (with RAS blockade vs. without RAS blockade). Moreover, Cox proportional hazard regression and Kaplan-Meier analyses were performed to examine the effects of RAS blockade on mortality and end-stage renal disease (ESRD).
RESULTS
A total of 8,460 patients were enrolled in this study, of whom 6,236 (73.7%) were prescribed with RAS blockade. The mean follow-up period was 129 months. A total of 1,003 (11.9%) patients died, of whom 273 (3.2%) died of cardiovascular (CV) events. The Kaplan-Meier curves for all-cause or CV mortality showed that the survival probability was significantly higher in the RAS blockade group than in the non-RAS blockade group. Multivariate Cox analysis also revealed RAS blockade significantly reduced the all-cause and CV mortality rates by 39.1% and 33.7%, respectively, compared with non-RAS blockade, even after adjusting for age, sex, and comorbid diseases; however, ESRD was not affected.
CONCLUSION
In this study, we found that RAS blockade was significantly associated with a reduction in mortality but not in the incidence of ESRD. However, 26.3% of the enrolled patients did not use RAS blockade. Physicians need to consider the usefulness of RAS blockade in hypertensive patients with proteinuria.

Keyword

Hypertension; Proteinuria; Renin-angiotensin system blockade; All-cause mortality; Cardiovascular mortality; End-stage renal disease

MeSH Terms

Follow-Up Studies
Humans
Hypertension
Incidence
Kidney Failure, Chronic
Korea
Mortality*
Prescriptions
Proteinuria*
Renin-Angiotensin System*

Figure

• 

  Fig. 1 Diagram of patient selection. Ten percent of the Korean population who underwent a health examination between 2002 and 2003 were randomly extracted, and the subjects were restricted to those with hypertension and proteinuria. We excluded events with repetitive identification and divided the patients into two groups according to whether or not they were treated with RAS blockade, defined as having at least two prescriptions for RAS blockade medication during the follow-up period. RAS, reninangiotensin system.

• 

  Fig. 2 Kaplan-Meier curves for (A) all-cause mortality, (B) cardiovascular mortality, and (C) ESRD. The Kaplan-Meier curves for all-cause and cardiovascular mortality showed that the survival probability in the RAS blockade group was significantly higher than that in the non-RAS blockade group. Conversely, the occurrence of ESRD was significantly increased in the RAS blockade group compared with the non-RAS blockade group. ESRD, endstage renal disease; RAS, renin-angiotensin system.

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