Comparative effects of angiotensin-converting enzyme inhibitors and angiotensin ii receptor blockers on the risk of pneumonia and severe exacerbations in patients with COPD
Journal
International Journal of COPD
Journal Volume
13
Pages
867-874
Date Issued
2018
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 effects of angiotensin-converting-enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) on the risk of pneumonia and severe exacerbations in patients with COPD. Patients and methods: All patients with COPD who used ACEis and ARBs for >90 days between 2000 and 2005 were recruited. Pairwise matching (1:1) of the ACEi and ARB groups resulted in two similar subgroups, with 6,226 patients in each. The primary outcomes were pneumonia and COPD exacerbations, and the secondary outcome was death. Results: During the follow-up period, the incidence of pneumonia was 7.20 per 100 person-years in the ACEi group and 5.89 per 100 person-years in the ARB group. The ACEi group had a higher risk of pneumonia (adjusted hazard ratio [aHR], 1.22; 95% CI, 1.15–1.29) than the ARB group. The incidence of severe exacerbations was 0.65 per person-year for the patients receiving ACEis and 0.52 per person-year for those receiving ARBs. The patients receiving ACEis had a higher risk of severe exacerbations (aHR, 1.19; 95% CI, 1.16–1.21) than those receiving ARBs. Similar trends were noted in terms of severe exacerbations requiring hospitalization (aHR, 1.24; 95% CI, 1.21–1.28) or emergency department visits (aHR, 1.16; 95% CI, 1.13–1.18), pneumonia requiring mechanical ventilation (aHR, 1.35; 95% CI, 1.24–1.47), and mortality (aHR, 1.33; 95% CI, 1.26–1.42). Conclusion: ARBs were associated with lower rates of pneumonia, severe pneumonia, and mortality than ACEis in patients with COPD. ? 2018 Lai et al.
SDGs
Other Subjects
angiotensin receptor antagonist; dipeptidyl carboxypeptidase inhibitor; angiotensin 1 receptor antagonist; dipeptidyl carboxypeptidase inhibitor; aged; Article; artificial ventilation; chronic obstructive lung disease; cohort analysis; comparative effectiveness; controlled study; death; disease association; disease exacerbation; drug sensitivity; emergency ward; female; follow up; high risk population; hospitalization; human; incidence; major clinical study; male; mortality rate; outcome assessment; pneumonia; treatment duration; administrative claims (health care); chronic obstructive lung disease; comparative study; disease exacerbation; factual database; middle aged; mortality; pneumonia; prognosis; proportional hazards model; protection; risk assessment; risk factor; Taiwan; time factor; Administrative Claims, Healthcare; Aged; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Databases, Factual; Disease Progression; Female; Humans; Incidence; Male; Middle Aged; Pneumonia; Prognosis; Proportional Hazards Models; Protective Factors; Pulmonary Disease, Chronic Obstructive; Risk Assessment; Risk Factors; Taiwan; Time Factors
Publisher
Dove Medical Press Ltd.
Type
journal article