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Editor's Note
March 9, 2020

Continuation of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in the Face of Kidney Disease Progression—Safe and Possibly Life Saving

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Division of Research, Kaiser Permanente Northern California, Oakland
  • 3Associate Editor, JAMA Internal Medicine
JAMA Intern Med. 2020;180(5):727. doi:10.1001/jamainternmed.2020.0300

According to the National Health and Nutrition Examination Survey, from 2011 to 2012, an estimated 12% of adults in the US used an angiotensin-converting enzyme inhibitor (ACE-I) and 5.8% used an angiotensin receptor blocker (ARB).1 In this issue of JAMA Internal Medicine, Qiao et al2 help inform the clinical quandary of what to do when patients taking these drugs show progression of kidney disease. They present results of a retrospective cohort study investigating the association of ACE-I/ARB discontinuation after kidney disease progression with subsequent morbidity and mortality. Qiao et al2 identified patients prescribed ACE-I/ARBs whose estimated glomerular filtration rate was less than 30 mL/min/1.73 m2 and compared clinical outcomes of 1233 patients who had ACE-I/ARB discontinued with a propensity score–matched sample of 2673 patients who did not. In a 5-year follow-up, ACE-I/ARB discontinuation was associated with an increased risk of both mortality (hazard ratio, 1.39; 95% CI, 1.20-1.60) and major adverse cardiovascular events (hazard ratio, 1.37; 95% CI, 1.20-1.56).

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