{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T18:08:30Z","timestamp":1772820510600,"version":"3.50.1"},"reference-count":82,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,6,5]]},"abstract":"\n Background<\/jats:title>\n \n Our objective is to estimate the effects associated with higher rates of renin\u2010angiotensin system antagonists, angiotensin\u2010converting enzyme inhibitors and angiotensin receptor blockers (\n ACEI<\/jats:styled-content>\n \/\n ARB<\/jats:styled-content>\n s), in secondary prevention for geriatric (aged >65 years) patients with new ischemic strokes by chronic kidney disease (\n CKD<\/jats:styled-content>\n ) status.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n The effects of\n ACEI<\/jats:styled-content>\n \/\n ARB<\/jats:styled-content>\n s on survival and renal risk were estimated by\n CKD<\/jats:styled-content>\n status using an instrumental variable (\n IV<\/jats:styled-content>\n ) estimator. Instruments were based on local area variation in\n ACEI<\/jats:styled-content>\n \/\n ARB<\/jats:styled-content>\n use. Data abstracted from charts were used to assess the assumptions underlying the instrumental estimator.\n ACEI<\/jats:styled-content>\n \/\n ARB<\/jats:styled-content>\n s were used after stroke by 45.9% and 45.2% of\n CKD<\/jats:styled-content>\n and non\u2010\n CKD<\/jats:styled-content>\n patients, respectively.\n ACEI<\/jats:styled-content>\n \/\n ARB<\/jats:styled-content>\n rate differences across local areas grouped by practice styles were nearly identical for\n CKD<\/jats:styled-content>\n and non\u2010\n CKD<\/jats:styled-content>\n patients. Higher\n ACEI<\/jats:styled-content>\n \/\n ARB<\/jats:styled-content>\n use rates for non\u2010\n CKD<\/jats:styled-content>\n patients were associated with higher 2\u2010year survival rates, whereas higher\n ACEI<\/jats:styled-content>\n \/\n ARB<\/jats:styled-content>\n use rates for patients with\n CKD<\/jats:styled-content>\n were associated with lower 2\u2010year survival rates. While the negative survival estimates for patients with\n CKD<\/jats:styled-content>\n were not statistically different from zero, they were statistically lower than the estimates for non\u2010\n CKD<\/jats:styled-content>\n patients. Confounders abstracted from charts were not associated with the instrumental variable used.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Higher\n ACEI<\/jats:styled-content>\n \/\n ARB<\/jats:styled-content>\n use rates had different survival implications for older ischemic stroke patients with and without\n CKD<\/jats:styled-content>\n .\n ACEI<\/jats:styled-content>\n \/\n ARB<\/jats:styled-content>\n s appear underused in ischemic stroke patients without\n CKD<\/jats:styled-content>\n as higher use rates were associated with higher 2\u2010year survival rates. This conclusion is not generalizable to the ischemic stroke patients with\n CKD<\/jats:styled-content>\n , as higher\n ACEI<\/jats:styled-content>\n \/\n ARBS<\/jats:styled-content>\n use rates were associated with lower 2\u2010year survival rates that were statistically lower than the estimates for non\u2010\n CKD<\/jats:styled-content>\n patients.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.009137","type":"journal-article","created":{"date-parts":[[2018,5,30]],"date-time":"2018-05-30T09:20:05Z","timestamp":1527672005000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Use of Angiotensin\u2010Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for Geriatric Ischemic Stroke Patients: Are the Rates Right?"],"prefix":"10.1161","volume":"7","author":[{"given":"John M.","family":"Brooks","sequence":"first","affiliation":[{"name":"Arnold School of Public Health, University of South Carolina, Columbia, SC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cole G.","family":"Chapman","sequence":"additional","affiliation":[{"name":"Arnold School of Public Health, University of South Carolina, Columbia, SC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manish","family":"Suneja","sequence":"additional","affiliation":[{"name":"University of Iowa Hospitals and Clinics, Iowa City, IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary C.","family":"Schroeder","sequence":"additional","affiliation":[{"name":"University of Iowa College of Pharmacy, Iowa City, IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle A.","family":"Fravel","sequence":"additional","affiliation":[{"name":"University of Iowa College of Pharmacy, Iowa City, IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen M.","family":"Schneider","sequence":"additional","affiliation":[{"name":"Schneider Research Associates, Des Moines, IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"June","family":"Wilwert","sequence":"additional","affiliation":[{"name":"Schneider Research Associates, Des Moines, IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi\u2010Jhen","family":"Li","sequence":"additional","affiliation":[{"name":"Arnold School of Public Health, University of South Carolina, Columbia, SC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A.","family":"Chrischilles","sequence":"additional","affiliation":[{"name":"University of Iowa College of Public Health, Iowa City, IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas W.","family":"Brenton","sequence":"additional","affiliation":[{"name":"Schneider Research Associates, Des Moines, IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marian","family":"Brenton","sequence":"additional","affiliation":[{"name":"Schneider Research Associates, Des Moines, IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Robinson","sequence":"additional","affiliation":[{"name":"University of Iowa College of Public Health, Iowa City, IA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e32833f3897"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000024"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2010.02472.x"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.5301\/JN.2011.6445"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1159\/000228536"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5000159"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0078465"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2009.12.034"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2009050546"},{"key":"e_1_3_5_11_2","first-page":"171","article-title":"\u2018To block or not to block\u2019; whether to continue renin\u2010angiotensin\u2010aldosterone system blockade in advanced chronic kidney disease","volume":"31","author":"Solbu MD","year":"2016","unstructured":"Solbu MD, Jardine AG. \u2018To block or not to block\u2019; whether to continue renin\u2010angiotensin\u2010aldosterone system blockade in advanced chronic kidney disease. 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