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. 2025 Dec;34(1):2483864.
doi: 10.1080/08037051.2025.2483864. Epub 2025 Mar 28.

Association between ACEI/ARB and short-term prognosis in dialysis patients with hypertension admitted to intensive care unit

Shuoyan An  1 , Zixiang Ye  2 , Wuqiang Che  1 , Yanxiang Gao  1 , Xiaoyan Duo  1 , Xingliang Li  1 , Jiahui Li  1 , Jingang Zheng  1   2
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Free article

Association between ACEI/ARB and short-term prognosis in dialysis patients with hypertension admitted to intensive care unit

Shuoyan An et al. Blood Press. 2025 Dec.
Free article

Abstract

Introduction: To investigate the association between angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) and short-term prognosis in dialysis patients with hypertension admitted to intensive care unit (ICU).

Methods: Patients with a diagnosis of hypertension and dialysis who received antihypertensive agents during hospitalisation were included. Based on whether treated with ACEI/ARB, patients were divided to ACEI/ARB group and non- ACEI/ARB group. In-hospital mortality and 30-day all-cause mortality were compared between the two groups in the overall participants and after propensity score matching.

Results: The study included 647 patients, among which 227 (34.70%) were treated with ACEI/ARB. Compared to the non-ACEI/ARB group, fewer patients in the ACEI/ARB group suffered from atrial fibrillation/flutter (17.2% vs 31.9%, p < 0.001). The overall hospital mortality rate was 5.1%, and 9.0% of patients died during the 30-day follow-up period. ACEI/ARB group were with better clinical outcomes during hospitalisation (2.2% vs 6.7%, p = 0.023) and after 30-day follow-up (5.3% vs 11.0%, p = 0.016). ACEI/ARB treatment was independently associated with lower risk of hospital mortality (OR 0.24, 96% CI: 0.051 - 0.82, p = 0.038) and 30-day mortality (HR 0.36, 95% CI:0.15-0.89, p = 0.029) after adjusting confounding factors. After propensity score matching (PSM, 112 pairs), the ACEI/ARB group showed higher in-hospital (99.1% vs 91.1%, p = 0.013) and 30-day (95.5% vs 88.4%, p = 0.048) survival rates compared to the control group. ACEI/ARB was identified as an independent protector for 30-day mortality in the matched cohort (HR 0.33, 95% CI: 0.11-0.95, p = 0.041).

Conclusion: ACEI/ARB treatment showed a significant association with improved in-hospital and 30-day outcomes in dialysis patients with hypertension in the ICU.

Keywords: ACEI/ARB; ICU patients; dialysis; hypertension; mortality.

Plain language summary

Purpose: This study examines whether treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) is associated with better in-hospital and 30-day outcomes in dialysis patients with hypertension admitted to the ICU.

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