C0409 - 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

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%).

Discussion: 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.