ArticleChest2021
Renin-Angiotensin-Aldosterone System Inhibitor Use and Mortality in Pulmonary Hypertension: Insights From the Veterans Affairs Clinical Assessment Reporting and Tracking Database.
Article in Chest, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06053580 (Repurposing Valsartan May Protect Against Pulmonary Hypertension), which is not on this map. Cited by 17 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Repurposing Valsartan May Protect Against Pulmonary Hypertension
Who cites it
17 citing papers in PubMed, 22 citations in OpenAlex.
- Effect of Famotidine on Outcomes in Pulmonary Arterial Hypertension: A Randomized Controlled Trial.Chest · 2025Trial
- Response to: Comment on: The renin-angiotensin system in models of pulmonary arterial hypertension vs primary hypertension.Hypertension research : official journal of the Japanese Society of Hypertension · 2026Article
- Repurposing Heart Failure Therapies in Pulmonary Arterial Hypertension: Mechanistic Rationale, Translational Evidence, and Clinical Perspectives for SGLT2 Inhibitors and Mineralocorticoid Receptor Antagonists.Medicina (Kaunas, Lithuania) · 2026Review
- Mas1 Receptor Activation is Necessary and Sufficient to Transduce ACE2 Effect in PAH, But Ang(1-7) Alone is Insufficient.Pulmonary circulation · 2025Article
- Nephrectomy and high-salt diet inducing pulmonary hypertension and kidney damage by increasing Ang II concentration in rats.Respiratory research · 2024Article
- Management of Pulmonary Hypertension in the Context of Heart Failure with Preserved Ejection Fraction.Current hypertension reports · 2024Review
- Correlation of ACE gene polymorphisms and platelet parameters with morning peak blood pressure in hypertensive patients.American journal of translational research · 2024Article
- Emerging vascular cell-specific roles for mineralocorticoid receptor: implications for understanding sex differences in cardiovascular disease.American journal of physiology. Cell physiology · 2023Review
- Potential long-term effects of SARS-CoV-2 infection on the pulmonary vasculature: Multilayered cross-talks in the setting of coinfections and comorbidities.PLoS pathogens · 2023Review
- Therapeutic targeting of mineralocorticoid receptors in pulmonary hypertension: Insights from basic research.Frontiers in cardiovascular medicine · 2023Review
- An algorithm to identify cases of pulmonary arterial hypertension from the electronic medical record.Respiratory research · 2022Article
- ACE2 trials suggest remodeling, not dilation, as primary therapeutic effect.Pulmonary circulation · 2022Article
- Pulmonary Hypertension in the Context of Heart Failure With Preserved Ejection Fraction.Chest · 2021Review
- Article
- Angiotensin II type 1 receptor mediates pulmonary hypertension and right ventricular remodeling induced by inhaled nicotine.American journal of physiology. Heart and circulatory physiology · 2021Article
- Effect of spironolactone use in pulmonary arterial hypertension - analysis from pivotal trial databases.Pulmonary circulationArticle
- Extrapulmonary manifestations of pulmonary arterial hypertension.Expert review of respiratory medicineReview
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Authors and funding
9 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundThe renin-angiotensin-aldosterone system (RAAS) contributes to pulmonary hypertension (PH) pathogenesis. Although animal data suggest that RAAS inhibition attenuates PH, it is unknown if RAAS inhibition is beneficial in PH patients. RESEARCH QUESTION: Is RAAS inhibitor use associated with lower mortality in a large cohort of patients with hemodynamically confirmed PH? STUDY DESIGN AND
methodsWe used the Department of Veterans Affairs Clinical Assessment Reporting and Tracking Database to study retrospectively relationships between RAAS inhibitors (angiotensin converting enzyme inhibitors [ACEIs], angiotensin receptor blockers [ARBs], and aldosterone antagonists [AAs]) and mortality in 24,221 patients with hemodynamically confirmed PH. We evaluated relationships in the full and in propensity-matched cohorts. Analyses were adjusted for demographics, socioeconomic status, comorbidities, disease severity, and comedication use in staged models.
resultsACEI and ARB use was associated with improved survival in unadjusted Kaplan-Meier survival analyses in the full cohort and the propensity-matched cohort. This relationship was insensitive to adjustment, independent of pulmonary artery wedge pressure, and also was observed in a cohort restricted to individuals with precapillary PH. AA use was associated with worse survival in unadjusted Kaplan-Meier survival analyses in the full cohort; however, AA use was associated less robustly with mortality in the propensity-matched cohort and was not associated with worse survival after adjustment for disease severity, indicating that AAs in real-world practice are used preferentially in sicker patients and that the unadjusted association with increased mortality may be an artifice of confounding by indication of severity.
interpretationACEI and ARB use is associated with lower mortality in veterans with PH. AA use is a marker of disease severity in PH. ACEIs and ARBs may represent a novel treatment strategy for diverse PH phenotypes.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.