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Combined use of renin-angiotensin-aldosterone system-acting agents: a cross-sectional study

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Abstract

Background Due to recent EU warnings and restrictions on the combined use of renin-angiotensin-aldosterone system (RAAS)-acting agents, and the seriousness of the associated harm, we analyzed the prescription of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) as dual therapy or associated with spironolactone. Setting An administrative claims database of a regional hospital in Romania. Methods We retrospectively included all adult patients hospitalized during 18 months in 2013–2014, discharged with a prescription of a RAAS-acting agent. Main outcome measures Counts of ACEIs and ARBs co-prescription, of ACEIs or ARBs combined with spironolactone, co-morbidities, co-medication, creatinine, and electrolytes assessment and values. Results Out of 1697 patients with a prescription of a RAAS-acting agent, 24 (1.4 %) were co-prescribed ACEIs and ARBs, and 416 (24.5 %) ACEIs or ARBs with spironolactone. Patients prescribed dual ACEI/ARB therapy and the ones with ACEI or ARB-spironolactone combination had significantly higher prevalence of increased creatinine level before discharge, compared to the ACEI and ARB monotherapy groups (48 and 31 % compared to 17 and 27 %). Subjects with diabetes, heart failure, ischaemic heart disease, or urea ≥40 mg/dL had higher odds of having ACEI or ARB-spironolactone combination compared to monotherapy, while hypertension and renal disease subjects had lower odds. Similar findings were comparing dual ACEI/ARB therapy to monotherapy except heart failure (not statistically significant). Conclusion Overall, the prevalence of use of dual therapy was low. The combined use of RAAS-acting agents was higher in patients with known risk factors for further renal function deterioration, compared to the ones without.

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Funding

This paper was published under the frame of European Social Fund, Human Resources Development Operational Programme 2007–2013, Project No. POSDRU/159/1.5/136893. The funding source had no involvement in the conduct of the study.

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Authors and Affiliations

  1. Drug Information Research Center, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

    Andreea Farcas, Camelia Bucsa & Cristina Mogosan

  2. Medical Informatics and Biostatistics Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 6 Pasteur Street, 400349, Cluj-Napoca, Romania

    Daniel Leucuta

  3. 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

    Dan Dumitrascu

Authors
  1. Andreea Farcas
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  2. Daniel Leucuta
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  3. Camelia Bucsa
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  4. Cristina Mogosan
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Correspondence to Daniel Leucuta.

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Farcas, A., Leucuta, D., Bucsa, C. et al. Combined use of renin-angiotensin-aldosterone system-acting agents: a cross-sectional study. Int J Clin Pharm 38, 1390–1397 (2016). https://doi.org/10.1007/s11096-016-0378-2

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  • DOI: https://doi.org/10.1007/s11096-016-0378-2

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