Effect of Renin–Angiotensin System Inhibition on Cardiovascular Events in Older Hypertensive Patients with Metabolic Syndrome

• Published in: Metabolism, clinical and experimental clinical and experimental, 2014-03, Vol.63 (3), p.392-399
• Main Authors: Zreikat, Hala H, Harpe, Spencer E, Slattum, Patricia W, Mays, D’arcy P, Essah, Paulina A, Cheang, Kai I
• Format: Article
• Language: English
• Subjects: Aged; Angiotensin converting enzyme inhibitor; Angiotensin Receptor Antagonists - adverse effects; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin receptor blocker; Angiotensin-Converting Enzyme Inhibitors - adverse effects; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - adverse effects; Antihypertensive Agents - therapeutic use; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular Diseases - chemically induced; Endocrinology & Metabolism; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Hypertension - drug therapy; Insulin resistance; Male; Medical sciences; Metabolic diseases; Metabolic Syndrome - drug therapy; Miscellaneous; Other metabolic disorders; Prospective Studies; Renin-Angiotensin System - drug effects; Vertebrates: anatomy and physiology, studies on body, several organs or systems
• ISSN: 0026-0495; 1532-8600
• DOI: 10.1016/j.metabol.2013.11.006

Abstract Objective Metabolic syndrome (MetS) is associated with cardiovascular disease (CVD). Insulin resistance has been hypothesized as the underlying feature of MetS. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are widely used antihypertensives that may improve insulin sensitivity. The aim of the study is to evaluate the effect of ACEI/ARB on incident CVD events in older hypertensive patients with MetS. Materials/Methods We used the Cardiovascular Health Study, a prospective cohort study of individuals > 65 years of age to evaluate ACEI/ARB use and time to CVD events (including coronary and cerebrovascular events). The study included 777 subjects who had hypertension and ATP III-defined MetS, but free of CVD and diabetes at baseline. Cox regression models were used to evaluate the effect of ACEI/ARB as compared to other antihypertensives on the time to the first CVD events. Results ACEI/ARB use was associated with a decreased risk of CVD events (adjusted HR = 0.658, 95 % C.I. [0.436–0.993]) compared to other antihypertensives. When CVD endpoints were evaluated separately, use of ACEI/ARB was associated with lower rates of angioplasty and coronary events (HR of 0.129 and 0.530 respectively, with 95 % CI [0.017–0.952] and [0.321–0.875]). Conclusions ACEI/ARB use was associated with a lower risk of CVD events in older hypertensive patients with MetS, primarily due to a reduction in coronary events. The potential protective effect of ACEI/ARB on CVD events in older individuals with MetS will need further confirmation from prospective studies.