{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:23:38Z","timestamp":1790169818755,"version":"4.1.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The comparative cardiovascular effectiveness of different renin\u2013angiotensin system (RAS) inhibitors in patients receiving maintenance hemodialysis remains uncertain, and current guideline recommendations largely assume therapeutic equivalence between angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the TriNetX multi-institutional database, we identified adults with ESKD who newly initiated ARB or ACEI therapy from 2006 to 2025. An active-comparator new-user design and 1:1 propensity score matching were applied. The primary outcome was 1-year major adverse cardiovascular events (MACE: myocardial infarction [MI], stroke, or all-cause mortality). Secondary outcomes included individual MACE components and hyperkalemia. Hazard ratios (HRs) were estimated using Cox models, and negative-control analyses assessed residual confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After matching, 55,894 patients were included. ARB was associated with a lower risk of MACE compared with ACEI users (30.3% vs. 35.0%; HR 0.85; 95% CI 0.83\u20130.88). Stroke (HR 0.90; 95% CI 0.86\u20130.94) and all-cause mortality (HR 0.75; 95% CI 0.71\u20130.78) were also associated with a lower risk, while MI risk was similar (HR 0.99; 95% CI 0.94\u20131.03). Hyperkalemia rates were comparable. Subgroup findings consistently favored ARBs across age, sex, diabetes, heart failure, CAD, and PAD strata. Negative-control outcomes showed no significant associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large real-world cohort of patients receiving maintenance hemodialysis, initiation of ARB was associated with lower risks of major adverse cardiovascular events, stroke, and all-cause mortality compared with ACEI. These findings suggest a potential difference in observed cardiovascular outcomes between ARBs and ACEIs in the hemodialysis population; however, causal inference is limited by the observational design.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1833065","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T15:15:08Z","timestamp":1781536508000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparative cardiovascular outcomes of renin\u2013angiotensin system inhibitors in patients receiving maintenance hemodialysis: a large real-world cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Jheng-Yan","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Nutrition, Chi Mei Medical Center","place":["Tainan, Taiwan"]},{"name":"Department of Public Health, College of Medicine, National Cheng Kung University","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keng-Wei","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Chiali","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Chi","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Chi Mei Medical Center","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsuan-Yuan","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Centre","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Min","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"327","DOI":"10.3400\/avd.ra.17-00051","article-title":"Cardiovascular disease in patients with end-stage renal disease on hemodialysis","volume":"10","author":"Aoki","year":"2017","journal-title":"Ann. 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