{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T02:03:59Z","timestamp":1790906639289,"version":"4.1.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,10,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Our objective was to determine patterns of antihypertensive agent use by stage of chronic kidney disease (CKD) and to evaluate the association between different classes of antihypertensive agents with nonrenal outcomes, especially in advanced\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              .\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We studied 3939 participants of the\n              <jats:styled-content style=\"fixed-case\">CRIC<\/jats:styled-content>\n              (Chronic Renal Insufficiency Cohort) study. Predictors were time\u2010dependent angiotensin\u2010converting enzyme inhibitor or angiotensin receptor blocker , \u03b2\u2010blocker, and calcium channel blocker use (versus nonuse of agents in each class). Outcomes were adjudicated heart failure events or death. Adjusted Cox models were used to determine the association between predictors and outcomes. We also examined whether the associations differed based on the severity of\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              (early [stage 2\u20133\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              ] versus advanced disease [stage 4\u20135\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              ]). During median follow\u2010up of 7.5\u00a0years, renin\u2010angiotensin\u2010aldosterone system inhibitor use plateaued during\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              stage 3 (75%) and declined to 37% by stage 5, while \u03b2\u2010blocker, calcium channel blocker, and diuretic use increased steadily with advancing\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              . Renin\u2010angiotensin\u2010aldosterone system inhibitor use was associated with lower risk of heart failure (hazard ratio, 0.79; 95% confidence interval, 0.67\u20130.97) and death (hazard ratio, 0.78; 95% confidence interval, 0.67\u20130.90), regardless of severity of\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              . Calcium channel blocker use was not associated with risk of heart failure or death, regardless of the severity of\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              . \u03b2\u2010Blocker use was associated with higher risk of heart failure (hazard ratio, 1.62; 95% confidence interval, 1.29\u20132.04) and death (hazard ratio, 1.22; 95% confidence interval, 1.03\u20131.43), especially during early\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05 for interaction).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Angiotensin\u2010converting enzyme inhibitor and angiotensin receptor blocker use decreased, while use of other agents\u00a0increased with advancing\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              . Use of agents besides angiotensin\u2010converting enzyme inhibitors or angiotensin receptor blockers may be associated with suboptimal outcomes in patients with\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              .\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.009992","type":"journal-article","created":{"date-parts":[[2018,9,26]],"date-time":"2018-09-26T09:01:47Z","timestamp":1537952507000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":37,"title":["Use of Antihypertensive Agents and Association With Risk of Adverse Outcomes in Chronic Kidney Disease: Focus on Angiotensin\u2010Converting Enzyme Inhibitors and Angiotensin Receptor Blockers"],"prefix":"10.1161","volume":"7","author":[{"given":"Elaine","family":"Ku","sequence":"first","affiliation":[{"name":"Division of Nephrology Department of Medicine University of California San Francisco CA"},{"name":"Division of Pediatric Nephrology Department of Pediatrics University of California San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles E.","family":"McCulloch","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of California San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Vittinghoff","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of California San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of California San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten L.","family":"Johansen","sequence":"additional","affiliation":[{"name":"Division of Nephrology Department of Medicine University of California San Francisco CA"},{"name":"Department of Epidemiology and Biostatistics University of California San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYP.0000000000000065"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011161"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011303"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-1755.2004.09221.x"},{"key":"e_1_3_2_6_2","article-title":"Use of renin\u2010angiotensin system blockade in advanced ckd: An NKF\u2010KDOQI controversies report","author":"Weir MR","unstructured":"Weir MR, Lakkis JI, Jaar B, Rocco MV, Choi MJ, Mattrix\u2010Kramer H, Ku E. 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