Impact of Angiotensin II Signaling Blockade on Clinical Outcomes in Patients with Inflammatory Bowel Disease
- PMID: 30725290
- PMCID: PMC6586494
- DOI: 10.1007/s10620-019-5474-4
Impact of Angiotensin II Signaling Blockade on Clinical Outcomes in Patients with Inflammatory Bowel Disease
Abstract
Background: Preclinical data demonstrate that activation of the renin-angiotensin system (RAS) contributes to mucosal inflammation, and RAS inhibition by angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) improves colitis in animal models. Less is known regarding the effects of RAS inhibition on clinical outcomes in inflammatory bowel disease (IBD) patients.
Aim: Evaluate the impact of ACEI and ARB on clinical outcomes in IBD.
Methods: Rates of IBD-related hospitalizations, operations, and corticosteroid use were evaluated retrospectively in two groups. First, 111 IBD patients taking an ACEI or ARB were compared to nonusers matched 1:1 based on sex, age, diagnosis, disease location, and hypertension diagnosis. Second, outcomes in a cohort of 130 IBD patients were compared prior to and during ACEI/ARB exposure.
Results: Compared to matched controls, all IBD patients together with ACEI/ARB exposure had fewer hospitalizations (OR 0.26, p < 0.01), operations (OR 0.08, p = 0.02), and corticosteroid prescriptions (OR 0.5, p = 0.01). Comparing outcomes before and during ACEI/ARB use, there were no differences in hospitalizations, operations, or corticosteroid use for all IBD patients together, but patients with UC had increased hospitalizations (0.08 pre- vs. 0.16 during ACEI/ARB exposure, p = 0.03) and decreased corticosteroid use (0.24 pre-ACEI/ARB vs. 0.12 during ACEI/ARB exposure, p < 0.01) during ACEI/ARB use.
Conclusions: IBD patients with ACEI/ARB exposure had fewer hospitalizations, operations, and corticosteroid use compared to matched controls. No differences in outcomes were observed in individuals on ACEI/ARB therapy when compared to a period of time prior to medication exposure.
Keywords: Angiotensin receptor blocker; Angiotensin-converting-enzyme inhibitor; Inflammatory bowel disease; RAS inhibition.
Conflict of interest statement
Similar articles
-
Is Chronic Kidney Disease Progression Influenced by the Type of Renin-Angiotensin-System Blocker Used?Nephron. 2019;143(2):100-107. doi: 10.1159/000500925. Epub 2019 Jun 14. Nephron. 2019. PMID: 31203280
-
ACE inhibitors and angiotensin receptor blockers differentially alter the response to angiotensin II treatment in vasodilatory shock.Crit Care. 2024 Apr 18;28(1):130. doi: 10.1186/s13054-024-04910-6. Crit Care. 2024. PMID: 38637829 Free PMC article. Clinical Trial.
-
Effect of Renin-Angiotensin system inhibition on cardiovascular events in older hypertensive patients with metabolic syndrome.Metabolism. 2014 Mar;63(3):392-9. doi: 10.1016/j.metabol.2013.11.006. Epub 2013 Nov 16. Metabolism. 2014. PMID: 24393433 Free PMC article.
-
The role of renin angiotensin system in the pathophysiology of rheumatoid arthritis.Mol Biol Rep. 2021 Sep;48(9):6619-6629. doi: 10.1007/s11033-021-06672-8. Epub 2021 Aug 20. Mol Biol Rep. 2021. PMID: 34417705 Review.
-
Reno-protective effects of renin-angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis.Diabetologia. 2012 Mar;55(3):566-78. doi: 10.1007/s00125-011-2398-8. Epub 2011 Dec 22. Diabetologia. 2012. PMID: 22189484 Free PMC article. Review.
Cited by
-
Drug Repurposing in Crohn's Disease Using Danish Real-World Data.Pragmat Obs Res. 2024 Feb 21;15:17-29. doi: 10.2147/POR.S444569. eCollection 2024. Pragmat Obs Res. 2024. PMID: 38404739 Free PMC article.
-
Cardiovascular manifestations of inflammatory bowel diseases and the underlying pathogenic mechanisms.Am J Physiol Regul Integr Comp Physiol. 2023 Aug 1;325(2):R193-R211. doi: 10.1152/ajpregu.00300.2022. Epub 2023 Jun 19. Am J Physiol Regul Integr Comp Physiol. 2023. PMID: 37335014 Free PMC article. Review.
-
Exploring the Impact of ACE Inhibition in Immunity and Disease.J Renin Angiotensin Aldosterone Syst. 2022 Aug 4;2022:9028969. doi: 10.1155/2022/9028969. eCollection 2022. J Renin Angiotensin Aldosterone Syst. 2022. PMID: 36016727 Free PMC article. Review.
-
Perindopril/Ambrosin Combination Mitigates Dextran Sulfate Sodium-Induced Colitis in Mice: Crosstalk between Toll-Like Receptor 4, the Pro-Inflammatory Pathways, and SIRT1/PPAR-γ Signaling.Pharmaceuticals (Basel). 2022 May 13;15(5):600. doi: 10.3390/ph15050600. Pharmaceuticals (Basel). 2022. PMID: 35631426 Free PMC article.
-
Assessing the impact of blood pressure in the development of inflammatory bowel disease.J Clin Hypertens (Greenwich). 2022 May;24(5):566-572. doi: 10.1111/jch.14477. Epub 2022 Apr 1. J Clin Hypertens (Greenwich). 2022. PMID: 35363426 Free PMC article.
References
-
- Dandona P, Dhindsa S, Ghanim H, Chaudhuri A. Angiotensin II and inflammation: the effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockade. J Hum Hypertens. 2007;21:20–27. - PubMed
-
- Ruiz-Ortega M, Ruperez M, Lorenzo O, et al. Angiotensin II regulates the synthesis of proinflammatory cytokines and chemokines in the kidney. Kidney Int Suppl. 2002;:S12–S22. - PubMed
-
- Fukuzawa M, Satoh J, Sagara M, et al. Angiotensin converting enzyme inhibitors suppress production of tumor necrosis factor-alpha in vitro and in vivo. Immunopharmacology. 1997;36:49–55. - PubMed
-
- Mizushima T, Sasaki M, Ando T, et al. Blockage of angiotensin II type 1 receptor regulates TNF-alpha-induced MAdCAM-1 expression via inhibition of NF-kappaB translocation to the nucleus and ameliorates colitis. Am J Physiol Gastrointest Liver Physiol. 2010;298:G255–G266. - PubMed
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Medical