1
|
Chien SC, Ou SM, Shih CJ, Chao PW, Li SY, Lee YJ, Kuo SC, Wang SJ, Chen TJ, Tarng DC, Chu H, Chen YT. Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in Terms of Major Cardiovascular Disease Outcomes in Elderly Patients: A Nationwide Population-Based Cohort Study. Medicine (Baltimore) 2015; 94:e1751. [PMID: 26512568 PMCID: PMC4985382 DOI: 10.1097/md.0000000000001751] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Renin and aldosterone activity levels are low in elderly patients, raising concerns about the benefits and risks of angiotensin-converting-enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARB) use. However, data from direct comparisons of the effects of ACEIs on ARBs in the elderly population remain inconclusive.In this nationwide study, all patients aged ≥ 70 years were retrieved from the Taiwan National Health Insurance database for the period 2000 to 2009 and were followed up until the end of 2010. The ARB cohort (12,347 patients who continuously used ARBs for ≥ 90 days) was matched to ACEI cohort using high-dimensional propensity score (hdPS). Intention-to-treat (ITT) and as-treated (AT) analyses were conducted.In the ITT analysis, after considering death as a competing risk, the ACEI cohort had similar risks of myocardial infarction (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.79-1.06), ischemic stroke (HR 0.98, 95% CI 0.90-1.07), and heart failure (HR 0.93, 95% CI 0.83-1.04) compared with the ARB cohort. No difference in adverse effects, such as acute kidney injury (HR 0.99, 95% CI 0.89-1.09) and hyperkalemia (HR 1.02, 95% CI 0.87-1.20), was observed between cohorts. AT analysis produced similar results to those of ITT analysis. We were unable to demonstrate a survival difference between cohorts (HR 1.03, 95% CI 0.88-1.21) after considering drug discontinuation as a competing risk in AT analysis.Our study supports the notion that ACEI and ARB users have similar risks of major adverse cardiovascular events (MACE), even in elderly populations.
Collapse
Affiliation(s)
- Shu-Chen Chien
- From the School of Pharmacy, College of Pharmacy, Taipei Medical University (S-CC), Department of Pharmacy, Taipei Medical University Hospital (S-CC), Clinical Research Center, Taipei Medical University Hospital (S-CC), School of Medicine, National Yang-Ming University (S-MO, C-JS, S-YL, Y-JL, S-CK, S-JW, D-CT, Y-TC), Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital (S-MO, S-YL, D-CT), Institute of Clinical Medicine, National Yang-Ming University, Taipei (S-MO, D-CT), Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan (C-JS), School of Medicine, Taipei Medical University (P-WC), Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University (P-WC), Department of Neurology, Taipei City Hospital, Ren Ai Branch, Taipei (Y-JL), National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County (S-CK), Division of Infectious Diseases, Taipei Veterans General Hospital (S-CK), Institute of Brain Science, National Yang-Ming University (S-JW), Department of Neurology, Neurological Institute, Taipei Veterans General Hospital (S-JW), Department of Family Medicine, Taipei Veterans General Hospital (T-JC), Department and Institute of Physiology, National Yang-Ming University (D-CT), Department of Chest, Taipei City Hospital, Heping Fuyou Branch (HC); and Division of Nephrology, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan (Y-TC)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Abstract
Eprosartan is an angiotensin II receptor antagonist (angiotensin II receptor blocker [ARB]) used in the treatment of hypertension. In large, randomized trials, eprosartan (with or without hydrochlorothiazide [HCTZ]) demonstrated superior antihypertensive efficacy to that of placebo and, when administered at comparable dosage regimens, had similar blood pressure-lowering effects to enalapril. Eprosartan was generally well tolerated in clinical trials and had a lower incidence of persistent dry cough than enalapril. Eprosartan has a neutral effect on metabolic parameters, such as serum lipid levels and glucose homeostasis, and a low propensity for pharmacokinetic drug interactions. The use of eprosartan or other ARBs in combination with HCTZ tends to reverse the potassium loss associated with thiazide diuretics. Independent of its antihypertensive effects, eprosartan was associated with improved clinical outcomes (primary composite endpoint of all causes of mortality and all cardiovascular and cerebrovascular events, including all recurrent events) compared with nitrendipine in a randomized, secondary prevention trial in hypertensive patients with previous cerebrovascular events (MOSES trial). Eprosartan also reduced blood pressure and was associated with a modest improvement in cognitive function in a large observational study in patients > or =50 years of age with newly diagnosed hypertension (OSCAR study). In both of these trials, additional antihypertensive therapy, such as HCTZ, was permitted. Therefore, eprosartan is a useful treatment option in the management of a broad range of patients with hypertension, and its use with HCTZ provides a rational combination regimen.
Collapse
|