The long-term impact of renin-angiotensin system (RAS) inhibition on cardiorenal outcomes (LIRICO): A randomized, controlled trial

Giuseppe Grandaliano, Valeria Saglimbene, Suetonia C. Palmer, Marinella Ruospo, Patrizia Natale, Ausilia Maione, Antonio Nicolucci, Mariacristina Vecchio, Gianni Tognoni, Jonathan C. Craig, Fabio Pellegrini, Giuseppe Lucisano, Jörgen Hegbrant, Rosario Ariano, Olga Lamacchia, Antonio Sasso, Susanna Morano, Tiziana Filardi, Salvatore De Cosmo, Deni A. ProcacciniLoreto Gesualdo, Giuseppe Palasciano, David W. Johnson, Marcello Tonelli, Giovanni F.M. Strippoli, Mauro Cignarelli, Maurizio Di Mauro, Giancarlo Tonolo, Luigi Elio Adinolfi, Alfonso Gigante, Luciano Carboni, Roberto Anichini, Cecilia Marino, Mario Querques, Silvana Manfrini, Bruno Cianciaruso, Stefano Del Prato, Francesco Giorgino, Paolo Cavallo Perin, Fabio Malberti, Alfio Nardo, Cecilia Invitti, Immacolata Panettieri, Mario Bono-Mini, Giorgio Sesti, Emanuele Altomare, Rosa Giordano, Alessandro Iacono, Tiziano Lusenti, Carlo Jovane, Ivana Zavaroni, Luigi Vernaglione, Juliette Grosso, Piero Stratta, Antonia Andriani, Alessio Montanaro, Agostino Di Ciaula, Giorgio Triolo, Antonio Santoro, Silvio Spada, Antonio Di Benedetto, Vito Borzì, Carla Tortul, Mario Schiavoni, Cesare Cavalera, Rossella Iannarelli, Giovanni Mileti, Salvatore Tardi, Salvatore Di Rosa

Risultato della ricerca: Contributo in rivistaEditoriale in rivista / quotidianopeer review

12 Citazioni (Scopus)

Abstract

Background The comparative effectiveness of treatment with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or their combination in people with albuminuria and cardiovascular risk factors is unclear. Methods In a multicenter, randomized, open label, blinded end point trial, we evaluated the effectiveness on cardiovascular events of ACE or ARB monotherapy or combination therapy, targeting BP,130/80 in patients with moderate or severe albuminuria and diabetes or other cardiovascular risk factors. End points included a primary composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for cardiovascular causes and a revised end point of all-cause mortality. Additional end points included ESRD, doubling of serum creatinine, albuminuria, eGFR, BP, and adverse events. Results Because of slow enrollment, the trial was modified and stopped 41% short of targeted enrollment of 2100 participants, corresponding to 35% power to detect a 25% reduced risk in the primary outcome. Our analysis included 1243 adults, with median follow-up of 2.7 years. Efficacy outcomes were similar between groups (ACE inhibitor versus ARB, ACE inhibitor versus combination, ARB versus combination) as were rates of serious adverse events. The rate of permanent discontinuation for ARB monotherapy (6.3%) was significantly lower than for ACE inhibitor monotherapy (15.7%) or combined therapy (18.3%). Conclusions Patients may tolerate ARB monotherapy better than ACE inhibitor monotherapy. However, data from this trial and similar trials, although as yet inconclusive, show no trend suggesting differences in mortality and renal outcomes with ACE inhibitors or ARBs as dual or monotherapy in patients with albuminuria and diabetes or other cardiovascular risk factors.
Lingua originaleEnglish
pagine (da-a)2890-2899
Numero di pagine10
RivistaJOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
Volume29
DOI
Stato di pubblicazionePubblicato - 2018

Keywords

  • renin angiotensin system
  • chronic kidney disease
  • Cardiovascular disease

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