Effect of Renin-Angiotensin System Blockade on Mortality in Korean Hypertensive Patients with Proteinuria
Background: Although renin-angiotensin system (RAS) blockade is recom- mended for hypertensive patients with proteinuria, the effect of RAS block- ade on Korean hypertensive patients has not been investigated. Methods: Among individuals who underwent a National Health Examination between 2002 and 2003 in Korea, hypertensive patients with proteinuria (defined as a dipstick test result ≥2+) were enrolled in this study. We in- vestigated the outcomes of two groups stratified by RAS blockade pre- scription (with RAS blockade vs. without RAS blockade). Moreover, Cox pro- portional hazard regression and Kaplan-Meier analyses were performed to examine the effects of RAS blockade on mortality and end-stage renal disease (ESRD). Results: A total of 8,460 patients were enrolled in this study, of whom 6,236 (73.7%) were prescribed with RAS blockade. The mean follow-up pe- riod was 129 months. A total of 1,003 (11.9%) patients died, of whom 273 (3.2%) died of cardiovascular (CV) events. The Kaplan-Meier curves for all- cause or CV mortality showed that the survival probability was significantly higher in the RAS blockade group than in the non-RAS blockade group. Multivariate Cox analysis also revealed RAS blockade significantly reduced the all-cause and CV mortality rates by 39.1% and 33.7%, respectively, compared with non-RAS blockade, even after adjusting for age, sex, and comorbid diseases; however, ESRD was not affected. Conclusion: In this study, we found that RAS blockade was significantly associated with a reduction in mortality but not in the incidence of ESRD. However, 26.3% of the enrolled patients did not use RAS blockade. Phy- sicians need to consider the usefulness of RAS blockade in hypertensive patients with proteinuria.