Efficacy of renin-angiotensin-aldosterone system blockades for acute phase hypertensive emergencies in patient complicating severe acute kidney injury

Watanabe, Kimio; Hamada, Takayuki; Shimada, Keiki; Fujimaru, Takuya; Itô, Yosiaki; Nagahama, Masayoshi; Taki, Fumika; Nakayama, Masaaki

doi:10.1007/s13730-021-00639-1

Cited by 4 publications

(9 citation statements)

References 8 publications

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“…Although the present study, as well as a case report by Watanabe et al [23], did not show a sudden decline in eGFR requiring discontinuation of RASi, these important issues need to be clari ed in future studies.…”

Section: Early Rasi Treatment and Renal Functioncontrasting

confidence: 49%

“…Rubin et al [9] demonstrated that the use of RASi at the acute phase with a very low dose was effective for controlling malignant hypertension. There is a case report showing that initiation of RASi on day 14 is associated with successful recovery of the renal function which persisted over 18 months [23]. In the present study, the use of RASi was commenced very early during hospitalization (2 nd day [IQR: 1.0-5.5]).…”

Section: Early Rasi Treatment and Renal Functionmentioning

confidence: 55%

“…Although the RAA system is markedly activated in hypertensive emergencies, very few studies have reported early use of RASi because of a potential risk of a rapid BP decline [9,23,24]. Rubin et al [9] demonstrated that the use of RASi at the acute phase with a very low dose was effective for controlling malignant hypertension.…”

Section: Early Rasi Treatment and Renal Functionmentioning

confidence: 99%

“…Hence, to the extent that both acute tubular injury and chronic tubulointerstitial damage coexist in malignant nephrosclerosis [29], more favorable effects of RASi might be anticipated when administered early during hospitalization (Figs. 1-3) [23]. Alternatively, there exists some controversy as to whether the use of RASi after AKI is associated with higher incidence of recurrent AKI and the subsequent risk for developing CKD [11,12,30].…”

Section: Early Rasi Treatment and Renal Functionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of early initiation of renin-angiotensin blockade on renal function and prognosis in patients with hypertensive emergency: A retrospective cohort study

Endo¹,

Hayashi

Hara³

et al. 2023

Preprint

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Background Hypertensive emergency is a critical disease that causes multifaceted sequelae, including end-stage kidney disease and cardiovascular disease. Although the renin-angiotensin-aldosterone (RAA) system is enormously activated in this disease, there are few reports that attempt to characterize the effect of early use of RAA inhibitors (RASi) on the temporal course of kidney function. Methods This retrospective cohort study was conducted to clarify whether the early use of RASi during hospitalization offered more favorable benefits on short-term renal function and long-term renal prognosis in patients with hypertensive emergencies. We enrolled a total of 49 patients who visited our medical center with acute severe hypertension and multiple organ dysfunction between April 2012 and August 2020. Upon admission, the patients were treated with intravenous followed by oral antihypertensive drugs, including RASi and Ca channel blockers (CCB). Kidney function as well as other laboratory and clinical parameters were compared between RASi-treated and other antihypertensive drugs-treated group over 2 years. Results Antihypertensive treatment effectively reduced blood pressure from 222 ± 4/142 ± 3 to 140 ± 3/87 ± 2 mmHg at 2 weeks and eGFR was gradually restored from 33.2 ± 3.3 to 41.1 ± 4.1mL/min/1.73m2 at 1 year. The renal effect of antihypertensive drugs was particularly conspicuous when RASi was started in combination with other conventional antihypertensive drugs at the early period of hospitalization (2nd day [IQR: 1-5.5]) and even in patients with moderately to severely diminished eGFR (< 30 mL/min/1.73 m2) on admission. In contrast, CCB modestly restored eGFR during the observation period. Furthermore, renal survival probabilities were progressively deteriorated in patients who had manifested reduced eGFR (< 15mL/min/1.73 m2) or massive proteinuria (urine protein/creatinine ≥ 3.5 g/gCr) on admission. Early use of RASi was associated with a favorable 2-year renal survival probability (0.90 [95%CI: 0.77-1.0] vs. 0.63 [95%CI: 0.34–0.92] for RASi(+) and RASi(-), respectively, p = 0.036) whereas no apparent difference in renal survival was noted for CCB, β-blocker, α-blockers, or diuretics. Conclusions Early use of RASi contributes to the renal functional recovery from acute reduction in eGFR among patients with hypertensive emergencies. Furthermore, RASi offers more favorable effect on 2-year renal survival, compared with other antihypertensive drugs.

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Section: Early Rasi Treatment and Renal Functioncontrasting

confidence: 49%

Section: Early Rasi Treatment and Renal Functionmentioning

confidence: 55%

Section: Early Rasi Treatment and Renal Functionmentioning

confidence: 99%

Section: Early Rasi Treatment and Renal Functionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of early initiation of renin-angiotensin blockade on renal function and prognosis in patients with hypertensive emergency: A retrospective cohort study

Endo¹,

Hayashi

Hara³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Although the RAA system is markedly activated in hypertensive emergencies, very few studies have reported early use of RASi because of a potential risk of a rapid BP decline [ 9 , 23 , 24 ]. Rubin et al [ 9 ] demonstrated that the use of RASi at the acute phase with a very low dose was effective for controlling malignant hypertension.…”

Section: Discussionmentioning

confidence: 99%

Impact of early initiation of renin-angiotensin blockade on renal function and clinical outcomes in patients with hypertensive emergency: a retrospective cohort study

Endo

Hayashi

Hara³

et al. 2023

BMC Nephrol

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Background Hypertensive emergency is a critical disease that causes multifaceted sequelae, including end-stage kidney disease and cardiovascular disease. Although the renin–angiotensin–aldosterone (RAA) system is enormously activated in this disease, there are few reports that attempt to characterize the effect of early use of RAA inhibitors (RASi) on the temporal course of kidney function. Methods This retrospective cohort study was conducted to clarify whether the early use of RASi during hospitalization offered more favorable benefits on short-term renal function and long-term renal outcomes in patients with hypertensive emergencies. We enrolled a total of 49 patients who visited our medical center with acute severe hypertension and multiple organ dysfunction between April 2012 and August 2020. Upon admission, the patients were treated with intravenous followed by oral antihypertensive drugs, including RASi and Ca channel blockers (CCB). Kidney function as well as other laboratory and clinical parameters were compared between RASi-treated and CCB- treated group over 2 years. Results Antihypertensive treatment effectively reduced blood pressure from 222 ± 28/142 ± 21 to 141 ± 18/87 ± 14 mmHg at 2 weeks and eGFR was gradually restored from 33.2 ± 23.3 to 40.4 ± 22.5 mL/min/1.73m2 at 1 year. The renal effect of antihypertensive drugs was particularly conspicuous when RASi was started in combination with other conventional antihypertensive drugs at the early period of hospitalization (2nd day [IQR: 1–5.5]) and even in patients with moderately to severely diminished eGFR (< 30 mL/min/1.73 m2) on admission. In contrast, CCB modestly restored eGFR during the observation period. Furthermore, renal survival probabilities were progressively deteriorated in patients who had manifested reduced eGFR (< 15 mL/min/1.73 m2) or massive proteinuria (urine protein/creatinine ≥ 3.5 g/gCr) on admission. Early use of RASi was associated with a favorable 2-year renal survival probability (0.90 [95%CI: 0.77–1.0] vs. 0.63 [95%CI: 0.34–0.92] for RASi ( +) and RASi (-), respectively, p = 0.036) whereas no apparent difference in renal survival was noted for CCB. Conclusions Early use of RASi contributes to the renal functional recovery from acute reduction in eGFR among patients with hypertensive emergencies. Furthermore, RASi offers more favorable effect on 2-year renal survival, compared with CCB.

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Successful treatment of severe renal failure caused by malignant hypertension using a combination of renin–angiotensin–aldosterone system inhibitors: a case report

Harada,

Maeoka,

Takahashi

et al. 2024

CEN Case Rep

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Marked activation of the renin–angiotensin–aldosterone system (RAAS) plays an important role in malignant hypertension (MHT) by worsening hypertension and renal function. The rates of readmission for severe hypertension and cardiovascular disease in such emergencies are high, suggesting that suppression of the RAAS may be inadequate during the acute phase in some cases. This report presents a case of MHT complicated with renal insufficiency (creatinine 3.93 mg/dL) and massive proteinuria, in which antihypertensive therapy, including an angiotensin receptor blocker, aliskiren, and spironolactone, normalized blood pressure (BP) and preserved renal function. Plasma renin activity was extremely high (131.9 ng/mL/h) on admission but normalized within almost 2 weeks. Although aliskiren and spironolactone were discontinued before discharge, BP was well controlled and renal function was further improved (creatinine 1.14 mg/dL) at follow-up 24 months later. This case of renal failure induced by MHT was successfully treated with a combination of RAAS inhibitors during the acute phase. The controlled BP and improved renal function in this patient suggest that adequate suppression of the RAAS cascade during the acute phase is potentially effective in terms of breaking the vicious cycle of MHT with hyperreninemia.

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Efficacy of renin-angiotensin-aldosterone system blockades for acute phase hypertensive emergencies in patient complicating severe acute kidney injury

Cited by 4 publications

References 8 publications

Impact of early initiation of renin-angiotensin blockade on renal function and prognosis in patients with hypertensive emergency: A retrospective cohort study

Impact of early initiation of renin-angiotensin blockade on renal function and prognosis in patients with hypertensive emergency: A retrospective cohort study

Impact of early initiation of renin-angiotensin blockade on renal function and clinical outcomes in patients with hypertensive emergency: a retrospective cohort study

Successful treatment of severe renal failure caused by malignant hypertension using a combination of renin–angiotensin–aldosterone system inhibitors: a case report

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