Philbin E F, Santella R N, Rocco T A
Section on Cardiac Transplantation, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan 48202, USA.
J Am Geriatr Soc. 1999 Mar;47(3):302-8. doi: 10.1111/j.1532-5415.1999.tb02993.x.
To examine the relationship between angiotensin-converting enzyme (ACE) inhibitor use and clinical outcomes among recently hospitalized patients with congestive heart failure (CHF) and coexisting renal insufficiency.
A prospective cohort study.
Ten community hospitals in upstate New York.
A total of 1076 hospital survivors identified from a consecutive series of CHF inpatients.
Patients were followed prospectively for 6 months after hospital discharge to track mortality, hospital readmission, and quality of life. Clinical outcomes were stratified by ACE inhibitor use among those with renal dysfunction, defined as serum creatinine > or = 2.0 mg/dL, and among the remaining patients, whose serum creatinine was < or = 1.9.
ACE inhibitor use was lower among 187 patients with renal dysfunction than among 889 patients with preserved function (41 vs 69%, P < .001). Age and sex were among the significant determinants of drug use in both groups. After adjustment for covariables, ACE inhibitor use among those with abnormal renal function was not associated with a lower risk for death or readmission, or better quality of life. By comparison, ACE inhibition conferred meaningful clinical benefit among those whose creatinine was < or = 1.9 mg/dL.
Convincing evidence of clinical benefit from ACE inhibitor use is not readily detectable among a sample of 187 unselected older patients with CHF and moderate or severe renal insufficiency. Further studies to identify subsets of this group who might benefit are warranted.
探讨血管紧张素转换酶（ACE）抑制剂的使用与近期住院的充血性心力衰竭（CHF）合并肾功能不全患者临床结局之间的关系。
一项前瞻性队列研究。
纽约州北部的十家社区医院。
从一系列连续的CHF住院患者中确定的1076名医院幸存者。
患者出院后进行6个月的前瞻性随访，以追踪死亡率、再次住院率和生活质量。临床结局按肾功能不全患者（定义为血清肌酐≥2.0mg/dL）和其余患者（血清肌酐≤1.9）中ACE抑制剂的使用情况进行分层。
187名肾功能不全患者中ACE抑制剂的使用率低于889名肾功能正常患者（41%对69%，P<.001）。年龄和性别是两组药物使用的重要决定因素。在对协变量进行调整后，肾功能异常患者使用ACE抑制剂与较低的死亡或再次住院风险以及更好的生活质量无关。相比之下，在肌酐≤1.9mg/dL的患者中，ACE抑制带来了有意义的临床益处。
在187名未经过筛选的老年CHF合并中度或重度肾功能不全患者样本中，未发现使用ACE抑制剂有令人信服的临床益处证据。有必要进行进一步研究以确定该组中可能受益的亚组。
