Acute Increases in Serum Creatinine After Starting Angiotensin-Converting Enzyme Inhibitor-Based Therapy and Effects of its Continuation on Major Clinical Outcomes in Type 2 Diabetes Mellitus

Discontinuation of angiotensin-converting enzyme (ACE) inhibitor is recommended if patients experience ≥30% acute increase in serum creatinine after starting this therapy. However, the long-term effects of its continuation or discontinuation on major clinical outcomes after increases in serum creati...

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Published in:Hypertension (Dallas, Tex. 1979) Tex. 1979), 2019-01, Vol.73 (1), p.84
Main Authors: Ohkuma, Toshiaki, Jun, Min, Rodgers, Anthony, Cooper, Mark E, Glasziou, Paul, Hamet, Pavel, Harrap, Stephen, Mancia, Giuseppe, Marre, Michel, Neal, Bruce, Perkovic, Vlado, Poulter, Neil, Williams, Bryan, Zoungas, Sophia, Chalmers, John, Woodward, Mark
Format: Article
Language:English
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Summary:Discontinuation of angiotensin-converting enzyme (ACE) inhibitor is recommended if patients experience ≥30% acute increase in serum creatinine after starting this therapy. However, the long-term effects of its continuation or discontinuation on major clinical outcomes after increases in serum creatinine are unclear. In the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation), 11 140 diabetes mellitus patients were randomly assigned to perindopril-indapamide or placebo after a 6-week active run-in period. The current study included 11 066 participants with 2 serum creatinine measurements recorded before and during the active run-in period (3 weeks apart). Acute increase in creatinine was determined using these 2 measurements and classified into 4 groups: increases in serum creatinine of
ISSN:1524-4563
DOI:10.1161/HYPERTENSIONAHA.118.12060