International Journal of Clinical Pharmacy

, Volume 38, Issue 6, pp 1390–1397 | Cite as

Combined use of renin-angiotensin-aldosterone system-acting agents: a cross-sectional study

  • Andreea Farcas
  • Daniel LeucutaEmail author
  • Camelia Bucsa
  • Cristina Mogosan
  • Dan Dumitrascu
Research Article


Background Due to recent EU warnings and restrictions on the combined use of renin-angiotensin-aldosterone system (RAAS)-acting agents, and the seriousness of the associated harm, we analyzed the prescription of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) as dual therapy or associated with spironolactone. Setting An administrative claims database of a regional hospital in Romania. Methods We retrospectively included all adult patients hospitalized during 18 months in 2013–2014, discharged with a prescription of a RAAS-acting agent. Main outcome measures Counts of ACEIs and ARBs co-prescription, of ACEIs or ARBs combined with spironolactone, co-morbidities, co-medication, creatinine, and electrolytes assessment and values. Results Out of 1697 patients with a prescription of a RAAS-acting agent, 24 (1.4 %) were co-prescribed ACEIs and ARBs, and 416 (24.5 %) ACEIs or ARBs with spironolactone. Patients prescribed dual ACEI/ARB therapy and the ones with ACEI or ARB-spironolactone combination had significantly higher prevalence of increased creatinine level before discharge, compared to the ACEI and ARB monotherapy groups (48 and 31 % compared to 17 and 27 %). Subjects with diabetes, heart failure, ischaemic heart disease, or urea ≥40 mg/dL had higher odds of having ACEI or ARB-spironolactone combination compared to monotherapy, while hypertension and renal disease subjects had lower odds. Similar findings were comparing dual ACEI/ARB therapy to monotherapy except heart failure (not statistically significant). Conclusion Overall, the prevalence of use of dual therapy was low. The combined use of RAAS-acting agents was higher in patients with known risk factors for further renal function deterioration, compared to the ones without.


Potential harm Renin-angiotensin-aldosterone system-acting agents  Romania Serum creatinine and potassium monitoring Utilization 



This paper was published under the frame of European Social Fund, Human Resources Development Operational Programme 2007–2013, Project No. POSDRU/159/1.5/136893. The funding source had no involvement in the conduct of the study.

Conflicts of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  • Andreea Farcas
    • 1
  • Daniel Leucuta
    • 2
    Email author
  • Camelia Bucsa
    • 1
  • Cristina Mogosan
    • 1
  • Dan Dumitrascu
    • 3
  1. 1.Drug Information Research Center“Iuliu Hatieganu” University of Medicine and PharmacyCluj-NapocaRomania
  2. 2.Medical Informatics and Biostatistics Department“Iuliu Hatieganu” University of Medicine and PharmacyCluj-NapocaRomania
  3. 3.2nd Medical Department“Iuliu Hatieganu” University of Medicine and PharmacyCluj-NapocaRomania

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