Risk of Sepsis and Mortality Among Patients With Chronic Obstructive Pulmonary Disease Treated With Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers
Journal
Critical Care Medicine
Journal Volume
47
Journal Issue
1
Pages
E14-E20
Date Issued
2019
Author(s)
Lai C.-C.
Wang Y.-H.
Wang C.-Y.
Chen L.
Taiwan Clinical Trial Consortium for Respiratory Diseases (TCORE)
Abstract
Objectives: This study aimed to compare the effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on the risk and outcomes of sepsis in patients with chronic obstructive pulmonary disease. Design: A retrospective study. Setting: Taiwan's National Health Insurance Research Database. Patients: All patients with chronic obstructive pulmonary disease who received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for more than 90 days between 2000 and 2005 were recruited for this study. Pairwise matching (1:1) of the angiotensin-converting enzyme inhibitor and angiotensin receptor blocker groups resulted in two similar subgroups with 5,959 patients in each. Interventions: None. Measurements and Main Results: The primary outcome was sepsis, and the secondary outcome was death. The occurrence rate of sepsis was 3.67 per 100 person-years for the patients receiving angiotensin-converting enzyme inhibitors and 2.87 per 100 person-years for those receiving angiotensin receptor blockers. In addition, the patients receiving angiotensin-converting enzyme inhibitors had a higher risk of septic shock (adjusted hazard ratio, 1.45; 95% CI, 1.26-1.67) and mortality (adjusted hazard ratio, 1.31; 95% CI, 1.22-1.40) than those receiving angiotensin receptor blockers. No matter whether the patients had prior severe exacerbation before the index date, those receiving angiotensin-converting enzyme inhibitors had a higher risk of sepsis, septic shock, and mortality than those receiving angiotensin receptor blockers (all p < 0.001). Conclusions: Angiotensin receptor blockers were associated with lower rates of sepsis and mortality than angiotensin-converting enzyme inhibitors in the patients with chronic obstructive pulmonary disease. The similar findings were also noted in subgroup analysis. Copyright ? 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
SDGs
Other Subjects
acetylsalicylic acid; alpha adrenergic receptor blocking agent; angiotensin receptor antagonist; beta adrenergic receptor blocking agent; beta adrenergic receptor stimulating agent; bronchodilating agent; calcium channel blocking agent; clopidogrel; corticosteroid; dipeptidyl carboxypeptidase inhibitor; dipyridamole; diuretic agent; hydroxymethylglutaryl coenzyme A reductase inhibitor; long acting drug; muscarinic receptor blocking agent; nitric acid derivative; nonsteroid antiinflammatory agent; proton pump inhibitor; short acting drug; ticlopidine; xanthine; angiotensin receptor antagonist; dipeptidyl carboxypeptidase inhibitor; adult; aged; antihypertensive therapy; Article; bacteremia; biliary tract infection; chronic obstructive lung disease; clinical outcome; comparative effectiveness; comparative toxicology; controlled study; disease exacerbation; female; follow up; human; hypertension; incidence; lower respiratory tract infection; major clinical study; male; mortality risk; priority journal; retrospective study; sepsis; septic shock; side effect; treatment duration; urinary tract infection; chronic obstructive lung disease; epidemiology; middle aged; mortality; sepsis; Taiwan; Adult; Aged; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Female; Humans; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Sepsis; Taiwan
Publisher
Lippincott Williams and Wilkins
Type
journal article