Evaluation of Effectiveness of Angiotensin Converting Enzyme Inhibitors, Angiotensin II Receptor Blockers and Beta Blockers in Long-term Dialysis Patients with Chronic Heart Failure

• Main Authors: Zhi-ying Hung, 洪資胤
• Other Authors: Shang-chi Hwang
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/54616706653628838942

碩士 === 高雄醫學大學 === 藥學系臨床藥學碩士班 === 105 === Background: Heart failure is a highly prevalent cardiovascular complication among patients receiving long-term dialysis. Almost every clinical trial would exclude dialysis patients, which led to the unclear of benefits of medication therapy in these patients. Consequently, this study would explore the effectiveness of drugs in long-term dialysis with chronic heart failure patients. Methods: National Taiwan health insurance database was used to analyze which drug class would be better in all-cause mortality in long-term dialysis with chronic heart failure patients. Intervention group was patients used ACEIs/ARBs first, and the control group was patients used beta blockers first. The same database was used to analyze which drug class would be better in protecting long-term dialysis patients without previous heart failure diagnosis from hospitalized heart failure. Results: From the total of 9,482 long-term dialysis patients with chronic heart failure, we selected 6,984 new users of the ACEIs/ARBs and 2,498 new users of the beta blockers. We found that beta blockers were associated with higher risk of death, compared to ACEIs/ARBs (HR=1.15; 95%C.I.=1.08-1.22; P value<0.001). Beta-blockers were associated with higher risk of death, compared to ACEIs/ARBs (HR=1.06; 95%C.I.= 0.96-1.18; P value=0.23). From the total of 12,778 long-term dialysis patients without previous heart failure diagnosis patients, we selected 8,698 new users of the ACEIs/ARBs and 4,081 new users of the beta blockers. We found that beta blockers were associated with higher risk of hospitalized heart failure, compared to ACEIs/ARBs (HR=1.13; 95%C.I.=1.05-1.22; P value<0.001). Conclusions: Beta blockers, prescribed in routine clinical practice to dialysis patients with chronic heart failure at first, were associated with higher risk of death, compared to ACEIs/ARBs at first., Beta blockers prescribed in routine clinical practice to dialysis patients without previous heart failure diagnosis at first, were associated with lower risk of hospitalized heart failure, compared to ACEIs/ARBs at first.