Poor Responders to RAAS Inhibition May Have Increased Cardiovascular Event Risk

Variabilities in systolic blood pressure and albuminuria occur between and within individual patients with type 2 diabetes (T2D) after initiating renin-angiotensin-aldosterone system (RAAS) inhibitors, according to results published in Diabetes, Obesity, and Metabolism.

Patients who responded poorly to RAAS inhibition had the highest risk for cardiovascular events and the study results stressed the need to develop personalized treatment plans for these patients.

The observational cohort study included patients from The Netherlands with T2D who started a RAAS inhibitor between 2007 and 2013 (n=1600). Systolic blood pressure and albuminuria were assessed within 15 months of follow-up.

The researchers categorized participants into 3 groups according to RAAS response: good responders (change in systolic blood pressure <0mmHg and change in albuminuria <0%), intermediate responders (change in systolic blood pressure <0mmHg and change in albuminuria >0% or change in systolic blood pressure >0mmHg and change in albuminuria <0%), and poor responders (change in systolic blood pressure >0mmHg and change in albuminuria >0%).

Of the 1600 participants, 51% (n=812) were good responders, 22% (n=353) had a good systolic blood pressure response but poor albuminuria response, 17% (n=268) had a good albuminuria response but poor systolic blood pressure response, and 10% (n=167) were poor responders.

The researchers found that after starting an RAAS inhibitor, mean systolic blood pressure change was –13.2 mmHg and median albuminuria was –36.6% with a large between individual variability, both in systolic blood pressure [5th to 95th percentile: –48.5 to 20] and albuminuria [5th to 95th percentile: –87.6 to 171.4].

Participants who were good responders had a lower risk of cardiovascular events when compared with participants who were poor responders (HR 0.51, 95% CI: 0.30 –0.86; P =0.012).

Disclosures

Dick de Zeeuw has consultancy agreements with the following companies: Abbvie, Astellas, Bristol-Meyers Squibb, Hemocue, Johnson & Johnson, Merck Sharpe & Dohme, Novartis, Reata Pharmaceuticals and Vitae. H.J. Lambers Heerspink has consultancy agreements with the following companies: Abbvie, Astellas, AstraZeneca, Boehringer Ingelheim, Fresenius, Janssen, Merck.

Reference

Apperloo EM, Pena MJ, de Zeeuw D, Denig P, Heerspink HJL. Individual variability in response to renin-angiotensin-aldosterone system inhibition predicts cardiovascular outcome in patients with type 2 diabetes: a primary care cohort study [published online January 18, 2018] Diabetes Obes Metab. doi:10.1111/dom.13226