Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and the risk of major adverse cardiac events in patients with diabetes and prior stroke: A nationwide study

Chia Jen Shih, Hung Ta Chen, Pei Wen Chao, Shu Chen Kuo, Szu Yuan Li, Chih Yu Yang, Der Cherng Tarng, Shuo Ming Ou, Yung Tai Chen

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Renin-angiotensin-aldosterone system blockers are the preferred antihypertensive medications in patients with diabetes and prior stroke. This study aimed to compare the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in terms of major adverse cardiac events (MACEs) in patients with diabetes who survived ischemic stroke. Methods: We conducted an observational, nationwide, propensity score-matched cohort study using Taiwan's National Health Insurance Research Database. Patients aged at least 20 years with type 2 diabetes who initiated ACEI (n=15 959) or ARB (n=23 929) use within 90 days after discharge for first ischemic stroke between January 2000 and December 2011 were allocated to ACEI and ARB groups, respectively. The primary outcomes were MACEs (myocardial infarction, ischemic stroke, and cardiovascular mortality). The secondary outcomes were hospitalization for acute kidney injury and hyperkalemia. Intention-to-treat and as-treated models were used. Results: Intention-to-treat analysis showed no significant difference between the ACEI and ARB groups in the outcomes of MACEs [hazard ratio (HR), 0.99; 95% confidence interval (CI), 0.95-1.04], including ischemic stroke (HR, 1.01; 95% CI, 0.97-1.06), myocardial infarction (HR, 1.06; 95% CI, 0.95-1.18), and cardiovascular mortality (HR, 0.98; 95% CI, 0.91-1.06). As-treated analysis produced similar results. Additionally, the groups showed no difference in the risk of hospitalization for acute kidney injury or hyperkalemia. Conclusion: Our study supports the hypothesis that the risks of MACEs and two additional secondary outcomes in patients with diabetes who survived ischemic stroke did not differ according to ACEI versus ARB use.

Original languageEnglish
Pages (from-to)567-575
Number of pages9
JournalJournal of Hypertension
Volume34
Issue number3
DOIs
Publication statusPublished - Mar 1 2016

Fingerprint

Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Stroke
Confidence Intervals
Hyperkalemia
Myocardial Infarction
Acute Kidney Injury
Hospitalization
Propensity Score
Intention to Treat Analysis
Mortality
National Health Programs
Renin-Angiotensin System
Taiwan
Type 2 Diabetes Mellitus
Antihypertensive Agents
Cohort Studies
Databases
Research

Keywords

  • angiotensin II receptor blockers
  • angiotensin-converting enzyme inhibitors
  • diabetes
  • epidemiology
  • ischemic stroke
  • major adverse cardiac events

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and the risk of major adverse cardiac events in patients with diabetes and prior stroke : A nationwide study. / Shih, Chia Jen; Chen, Hung Ta; Chao, Pei Wen; Kuo, Shu Chen; Li, Szu Yuan; Yang, Chih Yu; Tarng, Der Cherng; Ou, Shuo Ming; Chen, Yung Tai.

In: Journal of Hypertension, Vol. 34, No. 3, 01.03.2016, p. 567-575.

Research output: Contribution to journalArticle

Shih, Chia Jen ; Chen, Hung Ta ; Chao, Pei Wen ; Kuo, Shu Chen ; Li, Szu Yuan ; Yang, Chih Yu ; Tarng, Der Cherng ; Ou, Shuo Ming ; Chen, Yung Tai. / Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and the risk of major adverse cardiac events in patients with diabetes and prior stroke : A nationwide study. In: Journal of Hypertension. 2016 ; Vol. 34, No. 3. pp. 567-575.
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abstract = "Objective: Renin-angiotensin-aldosterone system blockers are the preferred antihypertensive medications in patients with diabetes and prior stroke. This study aimed to compare the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in terms of major adverse cardiac events (MACEs) in patients with diabetes who survived ischemic stroke. Methods: We conducted an observational, nationwide, propensity score-matched cohort study using Taiwan's National Health Insurance Research Database. Patients aged at least 20 years with type 2 diabetes who initiated ACEI (n=15 959) or ARB (n=23 929) use within 90 days after discharge for first ischemic stroke between January 2000 and December 2011 were allocated to ACEI and ARB groups, respectively. The primary outcomes were MACEs (myocardial infarction, ischemic stroke, and cardiovascular mortality). The secondary outcomes were hospitalization for acute kidney injury and hyperkalemia. Intention-to-treat and as-treated models were used. Results: Intention-to-treat analysis showed no significant difference between the ACEI and ARB groups in the outcomes of MACEs [hazard ratio (HR), 0.99; 95{\%} confidence interval (CI), 0.95-1.04], including ischemic stroke (HR, 1.01; 95{\%} CI, 0.97-1.06), myocardial infarction (HR, 1.06; 95{\%} CI, 0.95-1.18), and cardiovascular mortality (HR, 0.98; 95{\%} CI, 0.91-1.06). As-treated analysis produced similar results. Additionally, the groups showed no difference in the risk of hospitalization for acute kidney injury or hyperkalemia. Conclusion: Our study supports the hypothesis that the risks of MACEs and two additional secondary outcomes in patients with diabetes who survived ischemic stroke did not differ according to ACEI versus ARB use.",
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AU - Chen, Hung Ta

AU - Chao, Pei Wen

AU - Kuo, Shu Chen

AU - Li, Szu Yuan

AU - Yang, Chih Yu

AU - Tarng, Der Cherng

AU - Ou, Shuo Ming

AU - Chen, Yung Tai

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KW - epidemiology

KW - ischemic stroke

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