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Association between renin–angiotensin–aldosterone system blockade and clinical outcomes in patients with hypertension: real-world observation from a nationwide hypertension cohort

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Abstract

Objective

We investigated the association between the use of ACEi, ARB, or non-renin–angiotensin–aldosterone system inhibitors (non-RASi) and incident cardiovascular events in an unselected nationwide hypertension cohort.

Methods

The information regarding 2,025,849 patients who underwent general health checkup between 2010 and 2011 and were on antihypertensive medication was collected. Patients were allocated into ACEi, ARB, and non-RASi groups and followed until 2019. The outcomes of interest were myocardial infarction (MI), ischemic stroke (IS), atrial fibrillation (AF), heart failure (HF), and all-cause deaths.

Results

Patients on ACEi and ARB showed unfavorable baseline characteristics compared to those on non-RASi. After adjusting for covariates, the ACEi group showed lower risks of MI, AF, and all-cause deaths (HR (95% CI): 0.94 (0.89–0.99), 0.96 (0.92–1.00), and 0.93 (0.90–0.96), respectively), but similar risks of IS and HF (0.97 (0.92–1.01) and 1.03 (1.00–1.06), respectively), compared to the non-RASi group. Likewise, the ARB group showed decreased risks of MI, IS, AF, HF, and all-cause deaths (HR (95% CI): 0.93 (0.91–0.95), 0.88 (0.86–0.90), 0.86 (0.85–0.88), 0.94 (0.93–0.96), and 0.84 (0.83–0.85)), compared to the non-RASi group. Sensitivity analysis of patients taking a single antihypertensive medication showed similar results. In the propensity score matching (PSM) cohort, the ARB group showed similar risks of MI and decreased risks of IS, AF, HF, and all-cause deaths compared to the ACEi group.

Conclusions

ACEi and ARB users were associated with decreased risks of MI, IS, AF, HF, and all-cause deaths, compared to non-RASi users.

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Funding

This project is an investigator-initiated trial. This research was funded by a grant from Boryung Pharm (Seoul, Korea). The funder had no role in study design, data collection and analysis, preparation of the manuscript, or decision to submit results.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea

    Chan Soon Park, Tae-Min Rhee, Hyun Jung Lee, Jun-Bean Park, Yong-Jin Kim & Hyung-Kwan Kim

  2. Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea

    Bongseong Kim & Kyung-Do Han

  3. Cardiovascular Center, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea

    Hee-Sun Lee

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  1. Chan Soon Park
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Correspondence to Hyung-Kwan Kim.

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Conflict of interest

H.K.K reports research grants from HK inno.N, Johnson & Johnson, Handok Pharm, GSK, Samjin Pharm, ChongKunDang Pharm, Boryung Pharm, and JW Pharm. The remaining authors have nothing to disclose.

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Park, C.S., Kim, B., Rhee, TM. et al. Association between renin–angiotensin–aldosterone system blockade and clinical outcomes in patients with hypertension: real-world observation from a nationwide hypertension cohort. Clin Res Cardiol 112, 1577–1586 (2023). https://doi.org/10.1007/s00392-023-02179-3

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