S952 The Effect of Commonly Prescribed Renin-Angiotensin-Aldosterone System Blocking Agents on the 5- and 10-year Disease Course of Crohn’s Disease Patients With Hypertension
Bibliographic record
Abstract
Introduction: Activation of the renin-angiotensin-aldosterone system (RAAS) has been associated with gastrointestinal inflammation and fibrosis, suggesting that blockade may be beneficial in patients with inflammatory bowel disease (IBD). Using retrospective analysis, we aimed to compare the disease course of Crohn’s disease (CD) patients initiated on two commonly prescribed classes of RAAS-blocking agents. Methods: Patients with CD and hypertension who were initiated on an angiotensin-converting-enzyme inhibitor (ACEI, n=40) or angiotensin-receptor blocker (ARB, n=40) between 2000-2016 were included. A control group (n=40) was created and matched on gender, body mass index, CD Montreal classification, age at CD diagnosis, CD duration, and common comorbid conditions. Data was collected on surrogate markers of IBD severity in the 3-, 5-, and 10-years following ACEI or ARB initiation. Surrogate markers included clinical (emergency department visits, hospitalizations, corticosteroid use, and biologic therapy use), radiological (computer tomography [CT], CT enterography, magnetic resonance imaging, magnetic resonance enterography), and procedural (endoscopic procedures, IBD-related operations) variables. Statistical analysis was performed by one-way multivariate analysis of variance with Tukey post-hoc testing. Results: Compared to control, patients taking ARBs had fewer instances of systemic corticosteroid use (1.06 vs.2.88, p< 0.01, -63%) at the 10-year interval. On the other hand, patients taking ACEIs had an overall worse disease course, with more imaging studies (3.00 vs.1.75, p=0.03, +71%) and endoscopic procedures (2.70 vs. 1.78, p=0.01, +52%) at 5-years, and more imaging studies (6.19 vs.3.50, p< 0.01, +77%), endoscopic procedures (5.91 vs.3.78, p< 0.01, +56%), and IBD-related operations (0.59 vs.0.18, p< 0.02, +228%) at 10-years. ACEI-treated patients were also more likely to initiate biologic therapy compared to control (56.0% vs.32.3%) and ARB-treated patients (56.0% vs.17.4%). Conclusion: Our study provides insight into the long-term use of RAAS-blocking agents in patients with CD, suggesting that differences exist between commonly prescribed medication classes. While ACEIs were associated with an overall worse disease course at 5- and 10-years, patients taking ARBs were noted to have fewer instances of corticosteroid use at 10-years. Given the frequent use of ACEI and ARB therapy, future large-scale studies are needed to further explore the association RAAS-blockade and IBD disease course (Table). Table 1. - Summary of clinical, radiological, and procedural surrogate markers of inflammatory bowel disease severity in the 3-, 5-, and 10-years following initiation of renin-angiotensin-aldosterone system blocking therapy Variable Average number of events per patient 3 years 5 years 10 years CD-ACEI (n= 40) CD-ARB (n= 40) CD-Control (n= 40) p-value CD-ACEI (n= 40) CD-ARB (n= 40) CD-Control (n= 40) p-value CD-ACEI (n= 32) CD- ARB (n= 33) CD-Control (n= 40) p-value Emergency department visits (all) 1.25 1.50 1.90 0.33 2.52 2.30 2.60 0.87 5.34 3.91 6.1 0.10 Emergency department visits (abdominal pain) 0.58 0.48 0.48 0.87 1.05 0.60 0.75 0.29 2.34 0.91 1.70 < 0.02 Hospitalizations (abdominal pain) 0.18 0.15 0.25 0.72 0.38 0.23 0.28 0.56 0.88 0.30 0.65 0.07 Systemic corticosteroid use (single instances) 0.63 0.35 1.00 0.09 1.53 0.45 1.28 0.03 3.72 1.06 2.88 < 0.01 Abdominal imaging 2.05 1.55 1.25 0.12 3.00 1.83 1.75 < 0.02 6.19 2.73 3.50 < 0.01 Endoscopic procedures 1.45 0.90 1.05 0.12 2.70 1.60 1.78 < 0.01 5.91 2.61 3.78 < 0.01 Gastrointestinal operations 0.13 0.08 0.08 0.72 0.15 0.10 0.08 0.18 0.59 0.15 0.18 < 0.01 Values are expressed as average number of events per patient at 3-, 5-, and 10-years following initiation of either an angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB). In case of control patients, values represent the average number of events per patient at 3-, 5-, and 10-years following start of follow-up interval. Emergency department visits included all visits as well as visits with abdominal pain as the chief complaint. Hospitalization included only those with abdominal pain as the chief complaint. Systemic corticosteroid usage was defined as single instances of systemic corticosteroid therapy. Abdominal imaging was defined as imaging of the abdominal area with Crohn’s disease as the primary indication. Endoscopic procedures included colonoscopy, sigmoidoscopy, double balloon enteroscopy, esophagogastroduodenoscopy. Gastrointestinal operations were defined as operations with Crohn's disease as the primary indication (including colectomy, small bowel resection, ileocecectomy, and proctocolectomy). ACEI: Angiotensin-converting-enzyme inhibitor, ARB: Angiotensin receptor blocker, CD: Crohn’s disease
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".