Friday, 24 January 2014

RAAS inhibitors: do the benefits outweigh the negatives?

RAAS inhibitors are a useful tool in managing patients suffering left ventricular systolic dysfunction and heart failure. However these medications can be associated with a worsening in renal function, and this in turn is associated with a worse prognosis.

Hannah Clark and colleagues of the CCRE has studied the effect of worsening renal function on mortality in a meta-analysis of randomised controlled trials with participants taking RAAS inhibitors or placebo.  They found mortality was higher overall in participants whose renal function worsened compared to those with stable renal function, but this was less marked if RAAS inhibitors were used compared to placebo. They also demonstrated that the mortality benefit of using RAAS inhibitors was three times greater in the presence of worsened renal function than stable renal function. From this the authors concluded that patients should remain on RAAS inhibitors despite a worsening in renal function.

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