These researchers assessed the safety and efficacy of valsartan in the 5010 heart failure (HF) patients with renal dysfunction participating in the Valsartan in Heart Failure Trial given valsartan or placebo. At baseline, chronic kidney disease (CKD; estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2) was found in 58% and dipstick-positive proteinuria in 8% of patients. Dipstick-positive proteinuria was independently associated with mortality (HR 1.28; p=0.05) and first morbid event (HR 1.28; p=0.01). The increased risk of death associated with dipstickpositive proteinuria was similar for those with and without CKD, as was the hazard for first morbid event. Valsartan reduced eGFR compared with placebo to a similar extent (p=0.52) in those with CKD (mean reduction –3.6 mL/min/1.73m2) and those without CKD (mean reduction –4.0 mL/min/ 1.73m2) and by –3.8 mL/min/1.73/m2 in both groups combined. The beneficial effect of valsartan on first morbid events was similar in those with and without CKD (HR 0.86 vs HR 0.91; p=0.23) and was significant in those with CKD. The effect of valsartan on mortality did not differ between patients with and without CKD.
Practitioners may withhold treatment in order to ‘do no harm’. However, as this study shows, what we think is not always backed by the evidence. Given the high rates of renal disease and heart failure for Māori, the addition of an angiotensin II receptor antagonist (more commonly called an “ARB”, which stands for angiotensin receptor blocker) to ACE inhibitors may be appropriate.
Independent commentary by Dr. Matire Hardwood
Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.
Research Review publications are intended for New Zealand health professionals.
Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.
