Angiotensin Receptor Blockers Research Articles

OPTIHEART: Determinants and prognostic importance of optimal medical treatment in patients with heart failure with reduced ejection fraction discharged from a heart failure clinic from 2018 to 2020.

Heart failure (HF) is an increasing health problem globally. Profound sex-related differences have been observed regarding the cause, treatment, and prognosis of HF. To assess baseline predictors for achieving optimal medical treatment (OMT) and the prognostic importance of OMT for male and female patients who have attended a HF clinical program (HFCP). OPTIHEART was a retrospective study that included 870 consecutive patients with left ventricular ejection fraction (LVEF)<40% discharged from HFCP in 2018, 2019 or 2020 and followed in registers for a mean of 1083(SD 11.3) days. OMT was defined as receiving an angiotensin-converting-enzyme-inhibitor (ACEi), angiotensin-receptor blocker (ARB) or angiotensin-II-receptor blocker and nephrylisin-inhibitor (ARNI) AND a betablocker (BB) both in doses > 50% of target doses. Achieving OMT was associated with male sex (OR: 2.05 95%CI 1.44-2.97; P < 0.0001) independently of younger age, higher diastolic blood pressure (DBP), and lower creatinine. A lower rate of 5-point MACE was associated with achieved OMT (HR: 0.67 95%CI 0.50-0.90; P = 0.007) independently of female sex (HR: 0.64 95%CI 0.48-0.84; P = 0.002), younger age, never smoking and NYHA ≤ 2. The beneficial effect of OMT was insignificantly more pronounced in patients with male sex, older age, higher creatinine, lower DBP, and body mass index ≤25kg/m2. OMT was more frequently achieved in patients with male sex independently of age, DBP, and creatinine. Achieving OMT was associated with less 5-point MACE independently of female sex, younger age, never smoking and NYHA ≤ 2.

Therapeutic strategies to reverse cigarette smoke-induced ion channel and mucociliary dysfunction in COPD airway epithelial cells.

Cigarette smoke (CS) is a leading cause of chronic obstructive pulmonary disease (COPD). Here, we investigated whether the ion channel amplifier nesolicaftor rescues CS-induced mucociliary and ion channel dysfunction. Since CS increases expression of transforming growth factor-beta1 (TGF-β1), human bronchial epithelial cells (HBEC) from healthy donors were used for TGF-β1 and COPD donors (COPD-HBEC) for CS exposure experiments. CS and TGF-β1 induce mucociliary dysfunction by increasing MUC5AC and decreasing ion channel conductance important for mucus hydration. These include cystic fibrosis transmembrane conductance regulator (CFTR) and apical large-conductance, Ca2+-activated K+ (BK) channels. Nesolicaftor rescued CFTR and BK channel dysfunction, restored ciliary beat frequency (CBF), and decreased mucus viscosity and MUC5AC expression in CS-exposed COPD-HBEC. Nesolicaftor further reversed reductions in ASL volumes, CBF, and CFTR and BK conductance, and blocked the increase in extracellular signal-regulated kinase (ERK) signaling in TGF-β1-exposed normal HBEC. Mechanistically, nesolicaftor increased, as expected, binding of PCBP1 to CFTR mRNA, but surprisingly also to LRRC26 mRNA, which encodes the gamma subunit required for BK function. Similar to nesolicaftor, the angiotensin receptor blocker (ARB) losartan rescued TGF-β1-mediated decreases in PCBP1 binding to LRRC26 mRNA. In addition, the ARB telmisartan restored PCBP1 binding to CFTR and LRRC26 mRNAs to rescue CFTR and BK function in CS-exposed COPD-HBEC. Thus, nesolicaftor and ARBs act on the same target and were therefore neither additive nor synergistic in their actions. These data demonstrate that nesolicaftor and ARBs may provide benefits in COPD by improving ion channel function important for mucus hydration.

ACEi and ARBs as Primary Prevention of Cancer Therapy-Related Cardiomyopathy in Patients Undergoing Chemotherapy with Anthracyclines: A Systematic Review and Meta-Analysis.

Anthracyclines treat a myriad of malignancies; however, they are known to lead to cancer therapy-related cardiomyopathy (CTRC). Randomized controlled trials (RCTs) evaluating the role of angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) in primary prevention of CTRC have yielded mixed results. A systematic search of MEDLINE, Cochrane, and Scopus databases was performed to identify RCTs that evaluated outcomes in patients receiving anthracyclines and ACEi or ARBs versus control. The primary outcome was occurrence of CTRC. All data were pooled using a random-effects model. The final analysis included 10 RCTs, with 1049 patients assessed. The weighted follow-up period was 16.8months. The average age was 43.2years and 90% were female. Breast cancer (80%) and lymphomas (13%) were the most common malignancies. There was no statistically significant difference between the groups with regards to occurrence of CTRC (16% vs 24%; risk ratio (RR) 0.67, 95% confidence interval (CI) [0.31, 1.45]). Compared with control, ACEi/ARBs were associated with favorable absolute changes in left ventricular ejection fraction (LVEF) (standardized mean difference (SMD) + 1.20%, 95%CI [0.40, 2.00]), left ventricular end-diastolic volume (SMD - 0.36mL, 95%CI [- 0.66, - 0.06]), and left ventricular end-systolic volume (SMD - 1.04mL, 95%CI [- 1.79, - 0.29]). There was also a lower risk of arrhythmias in the ACEi/ARBs group compared to control (1.6% vs 8.0%; RR 0.30, 95%CI [0.10, 0.94]), but no difference in all-cause mortality (2.8% vs 3.2%; RR 0.82, 95%CI [0.26, 2.61]), or heart failure (1.2% vs 7.1%; RR 0.40, 95%CI [0.03, 4.54]). ACEi/ARBs therapy was not associated with a reduction in CTRC among patients with cancer receiving anthracyclines. However, there were favorable changes in LVEF and left ventricular remodeling with ACEi/ARBs therapy. Further large-scale studies are needed to better understand the potential role of ACEi/ARBs in preventing long-term cardiotoxicity.

Kidney Toxicity of Drugs for the Heart: An Updated Perspective

Cardiovascular drugs are widely used for the prevention and treatment of various cardiac and vascular disorders. However, some of these drugs can also cause adverse effects on the kidney, leading to acute or chronic renal dysfunction, electrolyte imbalances, and increased mortality. The mechanisms of drug-induced renal toxicity vary depending on the type and class of the drug, the dose and duration of exposure, and the patient’s characteristics and comorbidities. In this review, we summarize the current knowledge on the renal effects of some common cardiovascular drugs, such as diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta-blockers, antiplatelet agents, anticoagulants, and statins and proton-pump inhibitors. We also discuss the clinical implications and management strategies for preventing or minimizing drug-induced nephrotoxicity, as well as the potential role of oxidative stress in its pathogenesis.

Switching from ARBs to sacubitril/valsartan safely improves 24-hour ambulatory blood pressure in patients with advanced chronic kidney disease

Abstract Background We investigated the effects of sacubitril/valsartan, a first-in-class angiotensin receptor neprilysin inhibitor (ARNI), on 24-hour blood pressure (BP) and safety for 12 weeks in Japanese patients with non-dialysis advanced chronic kidney disease (CKD). Methods We conducted a prospective, single-arm exploratory study. Patients with non-dialysis CKD stage G4-5 (estimated glomerular filtration (eGFR) &amp;lt;30 mL/min/1.73 m2) who did not achieve their BP goals with angiotensin receptor blocker (ARB) administration, were enrolled and switched to sacubitril/valsartan. Primary and key secondary endpoints were changes from baseline in the 24-hour systolic BP (SBP) measured via ambulatory BP monitoring (ABPM) over 12 weeks and the safety, especially incidence of serum creatinine (Cr) increase (≥30% increase from baseline) and hyperkalemia. Results Thirty patients were enrolled, and 29 patients were switched to sacubitril/valsartan. Efficacy analysis was conducted on 26 patients. Baseline mean eGFR and office BP were 21.1±5.0 mL/min/1.73m2 and 149.4±23.7/80.7±11.9 mmHg, respectively. Baseline 24-hour, daytime, and nighttime BP were 139.6±17.7/77.0±7.8 mmHg, 143.5±18.5/79.6±8.7 mmHg, and 131.0±20.4/71.1±8.8 mmHg, respectively. After 12 weeks, changes in 24-hour, daytime, and nighttime SBP from baseline were -7.1±12.4 mmHg (P &amp;lt;0.01), -7.7±12.9 mmHg (P &amp;lt;0.01), and -5.8±15.8 mmHg (P = 0.07), respectively. No incidences of potassium values &amp;gt;6.0 mmol/L or serum Cr ≥30% increase from baseline were reported after sacubitril/valsartan initiation. Conclusions Switching from ARB to sacubitril/valsartan can safely enhance 24-hour antihypertensive treatment in patients with non-dialysis CKD G4-5 who do not achieve BP goals with ARBs. CLINICAL TRIALS REGISTRATION: Trial Number jRCT1031220149.

Ameliorative effects of Daidzein on heart, lung, and liver injuries in ovariectomized female Wistar rats undergoing unilateral ureteral obstruction: Role of angiotensin receptor blockers

Ameliorative effects of Daidzein on heart, lung, and liver injuries in ovariectomized female Wistar rats undergoing unilateral ureteral obstruction: Role of angiotensin receptor blockers

The role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in managing metabolic dysfunction-associated steatotic liver disease.

The role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in managing metabolic dysfunction-associated steatotic liver disease.

Perioperative management of antihypertensive agents.

A large proportion, possibly over half, of patients presenting for preoperative evaluation will be taking antihypertensive agents. The multiple classes of agents and their use in different combinations can make management decisions challenging. Poor blood pressure control and lack of evidence or conflicting evidence for certain agents can further complicate management. Appropriate antihypertensive management is important because it can have an effect on meaningful perioperative outcomes, including mortality. In this review, we discuss the factors that should be considered when making preoperative hypertension management decisions and we summarize the available evidence for the most common classes of antihypertensive agents, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and diuretics. In addition to preoperative management, the review includes information on perioperative and postoperative blood pressure management considerations. Where possible, we provide recommendations based on the available evidence and the guidance published by expert bodis. However, due to the variety of factors that may influence management, clinical decisions for individual patients must be made on a case-by-case basis.

A Randomized Open-Label Parallel-Group Study Evaluating the Efficacy and Safety of Candesartan Cilexetil and Amlodipine in Mild to Moderate Essential Hypertensives in a Tertiary Care Hospital in Chennai

Objective: This research compared the effectiveness of combining amlodipine and candesartan in treating mild to moderate hypertensive patients. It suggests using drugs from different groups to achieve target blood pressure levels, as per contemporary evidence-based medicine. Hypertension is a leading global health threat, causing early deaths and other health conditions.Materials and Methods: Newly diagnosed essential hypertensives with BP ≥140/90 to &lt;180/110 mmHg were screened for this randomized, prospective, open-label, 3-arm, interventional, phase IV study. Eligible patients were divided into 3 groups, with amlodipine or candesartan cilexetil as monotherapy in 2 arms and the third arm with amlodipine + candesartan for 12 weeks. All the efficacy parameters will be presented as a percentage change in the mean of blood pressure from baseline and were compared using ANOVA with p-value&lt;0.05 to be statistically significant.Results: Out of 90 patients randomized, 83 were included for analysis. While the reduction in systolic blood pressure by amlodipine, candesartan, and amlodipine + candesartan from baseline was 11.7, 13.1, and 19mm Hg, the reduction in diastolic blood pressure by amlodipine, candesartan, and amlodipine + candesartan was 6.2, 10.7 and 11.9 mmHg at the end of 12 weeks (p-value&lt;0.0001). Out of a total of 90 participants in the 3 groups, the incidence of adverse events was reported by 7 participants.Conclusion: The study found that combining a calcium channel blocker and an angiotensin receptor blocker was more effective and tolerable in treating mild to moderate essential hypertensives.

Efficacy and safety of Kunxian in IgA nephropathy.

Kunxian (KX) has been reported to be effective in treating Immunoglobulin A nephropathy (IgAN) and autoimmune disorders, such as lupus nephritis, but there is a lack of controlled trial on its effectiveness and safety for treating IgAN. This multicenter, prospective cohort study was conducted with individuals aged 18-60years with biopsy-confirmed primary IgAN, proteinuria greater than 0.75g/d, and estimated glomerular filtration rate (eGFR) greater than 60mL/min/1.73m2. Patients were treated with KX or Mycophenolate mofetil (MMF) after receiving a stable dose of an angiotensin-converting-enzyme inhibitor or angiotensin-receptor blocker for at least 4weeks. 67 patients were assigned to the KX group and 72 to the MMF group. The mean (standard deviation) eGFR was 87.75 (15.94) mL/min/1.73m2, and the mean (standard deviation) proteinuria was 1.70 (0.74) g/d. Patients in the KX group had a greater reduction in proteinuria than those in the MMF group did. Complete remission occurred in 43 patients (64.2%) in the KX group and 37 patients (51.4%) in the MMF group (hazard ratio [HR] 0.612, 95% CI 0.385-0.972, P = 0.038). Overall response occurred in 59 participants (88.1%) in the KX group and 59 participants (81.9%) in MMF group (HR 0.658, 95% CI 0.447-0.970, P = 0.034). Adverse events were observed in 6 patients (8.9%) in the KX group and 5 patients (6.9%) in the MMF group with no significant difference. Compared with MMF, KX was safe and significantly decreased proteinuria in IgAN.

Efficacy and safety of traditional Chinese medicine and SGLT2i, GLP‐1RA, and ACEI/ARB in the management of diabetic kidney disease: A systematic review and network meta‐analysis

AbstractBackgroundIn recent years, medications including sodium‐glucose cotransporter 2 inhibitors (SGLT2i), glucagon‐like peptide‐1 receptor agonists (GLP‐1RA), angiotensin‐converting enzyme inhibitors (ACEI), and angiotensin receptor blockers (ARBs) have been used to treat diabetic kidney disease (DKD). Increasing evidence has indicated that traditional Chinese medicine (TCM) can play an important role in these therapeutic approaches. To determine the most effective and safe therapeutic schedule for patients with DKD, a network meta‐analysis (NMA) was conducted.MethodsRandomized‐controlled trials (RCTs) including the following treatment regimens were checked: conventional treatment regimen (Placebo); ACEI; ARB; SGLT2i; TCM; GLP‐1RA; ARB combined with GLP‐1RA (ARB + GLP‐1RA); ACEI combined with ARB (ACEI + ARB); ARB combined with SGLT2i (ARB + SGLT2i); ACEI combined with SGLT2i (ACEI + SGLT2i); ACEI combined with TCM (ACEI + TCM); ARB combined with TCM (ARB + TCM), GLP‐1RA combined with TCM (GLP‐1RA + TCM); GLP‐1RA combined with SGLT2i (GLP‐1RA + SGLT2i); SGLT2i combined with TCM (SGLT2i + TCM); and GLP‐1RA combined with ACEI (GLP‐1RA + ACEI) for treating patients with DKD. For dichotomous variables and continuous variables, odds ratios (ORs) and mean differences (MDs) were derived. A pairwise and NMA analysis was performed to compare serum creatinine (Scr), blood urea nitrogen (BUN), glycosylated hemoglobin (HbA1c), and 24‐h urinary total protein (24 h UTP). Thereafter, the interventions were ranked according to the surface under the cumulative ranking curve (SUCRA).ResultsA total of 87 RCTs were included in our study, including 16 different types of treatments and 10,485 patients. Compared with the placebo group, the ACEI + TCM group showed the best efficacy in relieving 24 h UTP and BUN (MD = −0.74 g/24 h, 95% confidence interval [CI]: −1.20 to 0.28 g/24 h, SUCRA = 97.2% and MD = −3.40 mmol/L, 95% CI: −4.90 to 1.80 mmol/L, SUCRA = 97.5%, respectively). In terms of reducing Scr, the ACEI + TCM group showed significant improvements compared to the placebo group (MD = −24.00 μmol/L, 95% CI: −34.00 to 13.00 μmol/L, SUCRA = 91.4%), followed by the GLP‐1RA + TCM and GLP1RA + SGLT2i groups (MD = −22.00 μmol/L, 95% CI: −32.00 to 12.00 μmol/L, SUCRA = 89.0% and MD = −20.00 μmol/L, 95% CI: −32.00 to 8.80 μmol/L, SUCRA = 85.1%, respectively). The ARB + GLP‐1RA, ACEI+ SGLT2i, and GLP‐1RA + TCM groups were ranked among the top three in terms of HbA1c (MD = −1.60%, 95% CI: −2.30% to −0.85%, SUCRA = 91.8%, MD = −1.50%, 95% CI: −2.70% to 0.35%, SUCRA = 85.1%, and MD = −1.30%, 95% CI: −1.80% to −0.73%, SUCRA = 81.5%, respectively). In terms of adverse events, the GLP‐1RA + TCM group had the highest safety, whereas headaches, dizziness, hypotension, hypoglycemia, and gastrointestinal symptoms were common adverse reactions in most treatment regimens.ConclusionsThe treatment scheme of ACEI + TCM may be the best choice to reduce 24 h UTP, BUN, and Scr in patients with DKD, while ARB + GLP‐1RA had the best effect in reducing HbA1c. In terms of drug safety, the GLP‐1RA + TCM group had the lowest incidence of adverse events.

The role of ACE inhibitors and ARBs in preserving cognitive function via hypertension Management: A critical Update.

The role of ACE inhibitors and ARBs in preserving cognitive function via hypertension Management: A critical Update.

Sacubitril/Valsartan vs ACE Inhibitors orARBs: A Systematic Review and Meta-Analysis of Randomized Trials.

Sacubitril/Valsartan vs ACE Inhibitors orARBs: A Systematic Review and Meta-Analysis of Randomized Trials.

Pharmacological Mechanism and Clinical Research Progress of Cordyceps Sinensis Preparations (Bailing Capsules) in the Treatment of Chronic Kidney Disease

Chronic kidney disease (CKD) has a high incidence rate, and its treatment primarily focuses on managing the underlying condition, improving lifestyle, slowing the progression of renal dysfunction, and implementing renal replacement therapy when necessary. Cordyceps sinensis, a traditional remedy with over 2000 years of history in folk medicine, is known for its sweet taste and neutral nature. It is believed to nourish the lungs, strengthen the kidneys, and replenish essence and qi by acting on the lung and kidney meridians. Modern preparations of Cordyceps sinensis, such as Bailing capsules, are made from artificially fermented Cordyceps sinensis powder. Research has demonstrated the ability of Cordyceps sinensis to regulate immunity, reduce inflammation, and combat fibrosis. This article reviews the pharmacological mechanisms of Cordyceps sinensis in treating CKD, highlighting its anti-inflammatory, immunomodulatory, and renal function-enhancing effects. Clinical studies have shown that Cordyceps sinensis can lower inflammatory markers, improve kidney function, and exhibit synergistic effects when combined with angiotensin receptor blockers (ARBs) and other medications. Additionally, it is considered safe for use, making it a promising option for treating CKD in traditional Chinese medicine.

Effects of antihypertensives with and without IL-6 lowering properties on long-term blood pressure control: The prospective HELIUS cohort.

Effects of antihypertensives with and without IL-6 lowering properties on long-term blood pressure control: The prospective HELIUS cohort.

Renin inhibitors versus angiotensin receptor blockers for primary hypertension.

Renin inhibitors, which inhibit the first and rate-limiting step in the renin angiotensin system (RAS), are thought to be more effective than other RAS inhibitors in blocking the RAS. Previous meta-analyses have shown that renin inhibitors have a favourable tolerability profile in people with mild-to-moderate hypertension and a blood-pressure-lowering magnitude that is similar to that of angiotensin receptor blockers (ARBs). ARBs inhibit the RAS by interfering with the binding of angiotensin II with its receptors. ARBs are widely prescribed and recommended as first-line therapy by some hypertension guidelines. However, a drug's efficacy in lowering blood pressure cannot be considered as a definitive indicator of its effectiveness in reducing mortality and morbidity. The benefits and harms of renin inhibitors compared to ARBs in treating hypertension are unknown. To evaluate the benefits and harms of renin inhibitors compared to angiotensin receptor blockers in people with primary hypertension. On 26 January 2024, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials: Cochrane Hypertension's Specialised Register, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Ovid Embase. The World Health Organization International Clinical Trials Registry Platform and the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) were also searched for ongoing trials. We contacted authors of relevant papers regarding further published and unpublished work and checked the bibliographies of included studies and relevant systematic reviews. The searches had no language restrictions. We included randomised, double-blind, parallel-design clinical trials comparing renin inhibitors and ARBs for people with primary hypertension. Studies recruiting people with proven secondary hypertension were excluded. Two review authors independently selected the included trials, evaluated the risks of bias using the RoB 1 tool, and entered the data for analysis. We reported dichotomous outcomes as a risk ratio (RR) with a 95% confidence interval (CI) and continuous variables as mean difference (MD) with a 95% CI. The primary outcomes were all-cause mortality, total cardiovascular events, end-stage renal disease (ESRD), withdrawal due to adverse effects (WDAE), serious adverse events (SAE), and adverse events. The secondary outcomes were fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, fatal heart failure or hospitalisation for heart failure, systolic and diastolic blood pressure (SBP and DBP), and heart rate. We used the GRADE approach to rate our confidence in the evidence. We included 11 double-blind RCTs involving 6780 participants with mild primary hypertension and without cardiovascular complications (mean age range 52 to 59 years), with a mean follow-up ranging from four weeks to nine months. Risk of bias was low or unclear for most domains except for other bias, which was high risk for 10 of the 11 trials due to industry funding. All the studies compared aliskiren, the only marketed molecule in the class of renin inhibitors, with an ARB. The ARB comparator was losartan in four trials, valsartan in three trials, irbesartan in three trials, and telmisartan in one trial. There were very limited or no data on cardiovascular outcomes and ESRD. There may be little to no difference between renin inhibitors and ARBs in all-cause mortality (RR 0.35, 95% CI 0.07 to 1.64; 3 studies, 1932 participants; low-certainty evidence). There is probably little to no difference between renin inhibitors and ARBs in WDAE (RR 0.71, 95% CI 0.49 to 1.02; 9 studies, 4634 participants; moderate-certainty evidence), SAE (RR 0.75, 95% CI 0.45 to 1.27; 6 studies, 3283 participants; moderate-certainty evidence), and adverse events (RR 0.98, 95% CI 0.90 to 1.06; 10 studies, 4722 participants; moderate-certainty evidence). There is probably little to no difference between renin inhibitors and ARBs in lowering SBP (MD -0.25 mmHg, 95% CI -1.05 to 0.56; 10 studies, 4222 participants; moderate-certainty evidence) and there may be little to no difference in lowering DBP (MD 0.25 mmHg, 95% CI -0.14 to 0.64; 10 studies, 4222 participants; low-certainty evidence). The available RCT evidence suggests little to no difference between renin inhibitors and ARBs in terms of mortality, SAE, WDAE, adverse events, and blood pressure in people with mild primary hypertension. The evidence was derived from short-term trials with a limited occurrence of morbidity outcomes, leaving any potential differences unknown. Larger RCTs of longer duration with a wider range of participants and a focus on cardiovascular outcomes are needed.

Effects of Sacubitril/Valsartan According to Natriuretic Peptide Levels in Patients Enrolled in PARADIGM-HF and PARAGON-HF.

Effects of Sacubitril/Valsartan According to Natriuretic Peptide Levels in Patients Enrolled in PARADIGM-HF and PARAGON-HF.

Adherence to pharmacotherapy for secondary prevention of coronary heart disease: A registry-based prospective study.

Adherence to pharmacotherapy for secondary prevention of coronary heart disease: A registry-based prospective study.

Retrospective Analysis of the Outcomes of Mycophenolate Therapy in Retarding the Progression of Immunoglobulin A Nephropathy (REMISSION IgA)

Background IgA nephropathy (IgAN) is the most common form of glomerulonephritis globally, and a leading cause of end-stage kidney disease (ESKD). In India, IgAN accounts for 10-15% of kidney biopsies, often with nephrotic syndrome and renal impairment. Steroids are the mainstay of treatment, though the role of mycophenolate (MPA) is less explored. This study investigated the outcomes of MPA in IgAN. Materials and Methods This retrospective study included patients ≥18 years old with biopsy-proven IgAN from January 1, 2010, to December 31, 2017, and eGFR &gt;15 mL/min/1.73m2. Patients were treated with angiotensin receptor blockers (ARBs), steroids, and MPA based on disease activity. The cohort was divided into three groups: ARB, ARB+prednisolone, and ARB+prednisolone+MPA. eGFR and proteinuria data were collected at baseline, 12, 36, and 60 months and compared between groups. Results IgAN comprised 16.7% of kidney biopsies. The mean age of patients was 36.6±10.1 years, with 88.9% having hypertension. Over 60 months, eGFR decreased by 2 mL/min/1.73m2 in both groups, with 16.4% of patients in the MPA group progressing to ESKD, compared to 18.4% in the steroid group (p=0.42). Conclusion MPA, in addition to steroids and ARBs, may help mitigate IgAN progression, though there were no differences in ESKD progression. Further randomized controlled trials are needed to validate the role of MPA in IgAN treatment.

Association between guideline-directed medical therapy and reintervention risk following peripheral vascular interventions in patients with peripheral artery disease.

Reintervention following peripheral vascular intervention (PVI) for peripheral artery disease (PAD) is common. Guideline-directed medical therapy (GDMT) is recommended post-PVI, yet its association with reintervention outcomes remains unclear. We analyzed Vascular Quality Initiative registry data linked with Medicare outcome for patients undergoing PVI for PAD (2017-2018). GDMT was defined as the receipt of statin, antiplatelet, and angiotensin-converting enzyme or angiotensin receptor blocker (ACE/ARB) therapy if hypertensive at discharge. Competing risk analyses and conditional risk models assessed the reintervention outcome, and the recurrent reintervention outcomes within 2 years, by GDMT receipt, compliance with each GDMT element, the number of elements received, and GDMT rate across sites and operators in a 1:1 propensity score-matched cohort. We included 13,244 patients (mean age 72.0 ± 9.9, women 41.0%). The reintervention outcome did not differ by GDMT receipt (cumulative incidence: 43.0% [95% CI 41.0-44.9%] in no GDMT vs 41.2% [95% CI 39.4- 43.0%] in GDMT; subhazard ratio (sHR): 1.03 [95% CI 0.97-1.10]), compliance with GDMT elements, the number of elements received, or site and operator GDMT rates (sHR per 10% increase: 1.00 [95% CI 0.98-1.03] and 1.00 [95% CI 0.98-1.02]) (all p > 0.05). However, a higher operator GDMT rate reduced the recurrent reintervention risk (HR: 0.98 [95% CI 0.97-1.00], p = 0.026). Around 40% of patients undergoing a PVI experience reintervention within 2 years, but the outcome was not reduced with GDMT receipt, and higher GDMT rates by site and operators were not associated with reintervention risk. Future studies should focus on medication adherence, refills, and more granular GDMT data for PAD care surveillance postrevascularization.