Retrospective evaluation of a dose-dependent effect of angiotensin-converting enzyme inhibitors on long-term outcome in dogs with cardiac disease.
benazepril
congestive heart failure
dilated cardiomyopathy
enalapril
myxomatous mitral valve disease
Journal
Journal of veterinary internal medicine
ISSN: 1939-1676
Titre abrégé: J Vet Intern Med
Pays: United States
ID NLM: 8708660
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
revised:
22
07
2021
received:
04
01
2021
accepted:
22
07
2021
pubmed:
14
8
2021
medline:
1
10
2021
entrez:
13
8
2021
Statut:
ppublish
Résumé
Angiotensin-converting enzyme inhibitors (ACEIs) are commonly prescribed in dogs, but the ideal dosage is unknown. In dogs with cardiac disease, a dose-response relationship exists for ACEIs with respect to long-term outcome. One hundred forty-four dogs with cardiac disease, 63 with current or prior congestive heart failure. Retrospective medical record review. Cox proportional hazards models were used to determine variables associated with 2-year survival or survival from first-onset congestive heart failure (CHF). Median initial ACEI dosage was 0.84 (interquartile range [IQR], 0.56-0.98) mg/kg/day, and 108/144 (75%) of dogs received q12h dosing. No clinically relevant changes in renal function test results, serum electrolyte concentrations, or blood pressure occurred between initial prescription of ACEI and first reevaluation (median, 14 days later). In univariable analysis, higher ACEI dose was associated with increased survival from first-onset CHF (P = .005), and within the subgroup of dogs in CHF at the time of ACEI prescription, higher ACEI dose was associated with improved survival at 2 years (P = .04). In multivariable analysis, q12h dose frequency of ACEI (hazard ratio [HR], 0.30; 95% CI, 0.10-0.88; P = .03) and higher serum potassium concentration at visit 1 (HR, 0.39; 95% CI, 0.16-0.97; P = .04) were predictive of 2-year survival. The ACEIs were well-tolerated, with only 8/144 (5.6%) dogs having ACEI dose decreased or discontinued because of adverse effects. Twice daily dose frequency might optimize the cardioprotective benefit of ACEIs.
Sections du résumé
BACKGROUND
BACKGROUND
Angiotensin-converting enzyme inhibitors (ACEIs) are commonly prescribed in dogs, but the ideal dosage is unknown.
HYPOTHESIS/OBJECTIVES
OBJECTIVE
In dogs with cardiac disease, a dose-response relationship exists for ACEIs with respect to long-term outcome.
ANIMALS
METHODS
One hundred forty-four dogs with cardiac disease, 63 with current or prior congestive heart failure.
METHODS
METHODS
Retrospective medical record review. Cox proportional hazards models were used to determine variables associated with 2-year survival or survival from first-onset congestive heart failure (CHF).
RESULTS
RESULTS
Median initial ACEI dosage was 0.84 (interquartile range [IQR], 0.56-0.98) mg/kg/day, and 108/144 (75%) of dogs received q12h dosing. No clinically relevant changes in renal function test results, serum electrolyte concentrations, or blood pressure occurred between initial prescription of ACEI and first reevaluation (median, 14 days later). In univariable analysis, higher ACEI dose was associated with increased survival from first-onset CHF (P = .005), and within the subgroup of dogs in CHF at the time of ACEI prescription, higher ACEI dose was associated with improved survival at 2 years (P = .04). In multivariable analysis, q12h dose frequency of ACEI (hazard ratio [HR], 0.30; 95% CI, 0.10-0.88; P = .03) and higher serum potassium concentration at visit 1 (HR, 0.39; 95% CI, 0.16-0.97; P = .04) were predictive of 2-year survival. The ACEIs were well-tolerated, with only 8/144 (5.6%) dogs having ACEI dose decreased or discontinued because of adverse effects.
CONCLUSIONS AND CLINICAL IMPORTANCE
CONCLUSIONS
Twice daily dose frequency might optimize the cardioprotective benefit of ACEIs.
Identifiants
pubmed: 34387901
doi: 10.1111/jvim.16236
pmc: PMC8478030
doi:
Substances chimiques
Angiotensin-Converting Enzyme Inhibitors
0
Potassium
RWP5GA015D
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2102-2111Informations de copyright
© 2021 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
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