Blockade of Renin-Angiotensin-Aldosterone System in Elderly Patients with Heart Failure and Chronic Kidney Disease: Results of a Single-Center, Observational Cohort Study.

Abstract

Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEis/ARBs) and mineralocorticoid receptor antagonists (MRAs) have been shown to benefit patients with heart failure with reduced ejection fraction (HFrEF). However, there is a lack of information on the advantages of these drugs for patients with chronic kidney disease (CKD), and this gap is especially pronounced in elderly patients. The objective of this study was to assess the role of treatment consisting of ACEi/ARBs and MRAs in patients ≥ 75years of age with CKD. From January 2008 to July 2014, 390 consecutive patients ≥ 75years of age with an ejection fraction ≤ 35% and a glomerular filtration rate (GFR) ≤ 60mL/min/1.73m2 were included. We analyzed the relationship between treatment with ACEi/ARBs and MRAs and mortality or cardiovascular events. Three hundred and ninety patients were included, with a mean age of 82.6 ± 4.1years. Mean ejection fraction was 27.9 ± 6.5%. Renal dysfunction was mild (GFR 45-60mL/min/1.73m2) in 50.3% of patients, moderate (GFR 30-44mL/min/1.73m2) in 37.4%, and severe (GFR < 30mL/min/1.73m2) in 12.3%. After 32 ± 23months, 68.7% of patients were receiving ACEi/ARBs and 40% were receiving MRAs; 65.9% developed a cardiovascular event and 54.4% had died. After multivariate Cox regression analysis, ACEi/ARB treatment was independently associated with a decreased rate of cardiovascular events (hazard ratio 0.71 [95% confidence interval 0.50-0.98]) and MRAs were not associated with a decrease in cardiovascular events or total mortality. Treatment with ACEi/ARBs in elderly patients with HFrEF and CKD was associated with a lower rate of cardiovascular events, though MRA treatment failed to reduce the risk of morbidity and mortality in our population.