Abstract

THE EFFECT OF ANGIOTENSIN CONVERTING ENZYME INHIBITORS AND/OR ANGIOTENSIN RECEPTOR BLOCKERS VERSUS CALCIUM CHANNEL BLOCKERS ON FREQUENCY OF CARDIOVASCULAR EVENTS IN PATIENTS WITH HYPERTENSION AND CHRONIC KIDNEY DISEASE IN SUDAN

Israa S. Abdelrahim*, Hasan Abu-Aisha and Abduelmula R. Abduelakrem

Abstract

Background: Patients with chronic kidney disease (CKD) have an elevated risk for major cardiovascular (CV) morbidity and mortality above that anticipated from their other accompanying risk factors. Reports from cumulative data suggest treatment of hypertension (HTN) would reduce the incidence of stroke by 35% -40%, myocardial infarction by 20%-24%, and heart failure>50%. The aim of this study was to compare the effect of angiotensin converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs) versus calcium channel blockers (CCBs) as used by physicians treating CKD patients who also had hypertension, on the degree of control of blood pressure and the frequency of occurrence of CV events over a span of about one year. Methods: The current study is a prospective study of 240 adult patients with CKD and HTN who were treated by their respective physicians in three major hospitals in Khartoum, Sudan. The patients were divided into two groups according to their medical records: those who were treated with ACEIs and/ or ARBs were designated as Group 1 (n=130) and those treated with CCBs designated as Group 2, (n = 110). Both groups were comparable in demographic characteristics. The patients were reviewed in detail on two separate occasions about one year apart and labeled as ‘Presentation 1 and 2’ (P1 and P2); all the relevant medical data were recorded and the patients examined clinically. The response of the blood pressure to medical treatment was recorded and the renal and CV complications documented. The effects on the kidney functions were reported previously and in this communication we concentrate on the CV effects over one year of follow up (FU). Results: Overall the effects of ACEIs /ARBs on the degree of control of BP were comparable to those of CCBs up to one year of FU, there being no statistically significant differences between the mean systolic blood pressure (SBP) and mean of diastolic blood pressure (DBP) in P1 and P2. In the span of about one year, 36 of all the 240 (15%) patients in the study developed CV events. The CV events recorded were acute coronary syndrome (ACS), heart failure, atrial fibrillation and cerebrovascular accidents. The total of these events were 14 in Group 1 and 22 in Group 2 (p =0.023). Of special note was the observation that ischemic stroke occurred more often in Group 2 compared to Group 1 (7:2), (p=0.028). Ten of the 240 patients (4.2%) died due to causes attributed to CV events. Although there were more cases in Group 2 compared to Group 1 (7:3), the statistical difference was not significant (p = 0.832). Conclusions: We conclude that the use of ACEIs and/or ARBs resulted in comparable degree of control of blood pressure to the use of CCBs in patients with CKD and hypertension. However, CV events occurred more commonly in the group treated with CCBs compared to the group treated with ACEIs/ARBs in a FU period of just over one year.

Keywords: angiotensin converting enzyme inhibitors, angiotensin receptor blockers, calcium chennal blockers, Hypertension, chronic kidney disease, cardiovascular complication.