Imperial College London
Alternate

Professor Neil Poulter

Faculty of Medicine, School of Public Health

Professor of Preventive Cardiovascular Medicine.
 
 
 
//

Contact

 

+44 (0)20 7594 3446n.poulter

 
 
//

Assistant

 

Mrs Ranjit Rayat +44 (0)20 7594 3445

 
//

Location

 

55Stadium HouseWhite City Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Ohkuma:2019:10.1161/HYPERTENSIONAHA.118.12060,
author = {Ohkuma, T and Jun, M and Rodgers, A and Cooper, ME and Glasziou, P and Hamet, P and Harrap, S and Mancia, G and Marre, M and Neal, B and Perkovic, V and Poulter, N and Williams, B and Zoungas, S and Chalmers, J and Woodward, M and ADVANCE, Collaborative Group},
doi = {10.1161/HYPERTENSIONAHA.118.12060},
journal = {Hypertension},
pages = {84--91},
title = {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},
url = {http://dx.doi.org/10.1161/HYPERTENSIONAHA.118.12060},
volume = {73},
year = {2019}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - 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 <10%, 10% to 19%, 20% to 29%, and ≥30%. The primary study outcome was the composite of major macrovascular events, new or worsening nephropathy, and all-cause mortality. An acute increase in serum creatinine was associated with an elevated risk of the primary outcome ( P for trend <0.001). The hazard ratios were 1.11 (95% CI, 0.97-1.28) for those with an increase of 10% to 19%, 1.34 (1.07-1.66) for 20% to 29%, and 1.44 (1.15-1.81) for ≥30%, compared with <10%. However, there was no evidence of heterogeneity in the benefit of randomized treatment effects on the outcome across subgroups defined by acute serum creatinine increase ( P for heterogeneity=0.94). Acute increases in serum creatinine after starting perindopril-indapamide were associated with greater risks of subsequent major clinical outcomes. However, the continuation of angiotensin-converting enzyme inhibitor-based therapy reduced the long-term risk of major clinical outcomes, irrespective of acute increase in creatinine. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00145925.
AU  - Ohkuma,T
AU  - Jun,M
AU  - Rodgers,A
AU  - Cooper,ME
AU  - Glasziou,P
AU  - Hamet,P
AU  - Harrap,S
AU  - Mancia,G
AU  - Marre,M
AU  - Neal,B
AU  - Perkovic,V
AU  - Poulter,N
AU  - Williams,B
AU  - Zoungas,S
AU  - Chalmers,J
AU  - Woodward,M
AU  - ADVANCE,Collaborative Group
DO  - 10.1161/HYPERTENSIONAHA.118.12060
EP  - 91
PY  - 2019///
SN  - 0194-911X
SP  - 84
TI  - 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
T2  - Hypertension
UR  - http://dx.doi.org/10.1161/HYPERTENSIONAHA.118.12060
UR  - https://www.ncbi.nlm.nih.gov/pubmed/30571562
UR  - http://hdl.handle.net/10044/1/66141
VL  - 73
ER  -
Download