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

Shu Chen Chien, Shuo Ming Ou, Chia Jen Shih, Pei Wen Chao, Szu Yuan Li, Yi Jung Lee, Shu Chen Kuo, Shuu Jiun Wang, Tzeng Ji Chen, Der Cherng Tarng, Hsi Chu, Yung Tai Chen

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Renin and aldosterone activity levels are low in elderly patients, raising concerns about the benefits and risks of angiotensinconvertingenzyme 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.

Original languageEnglish
Article numbere1751
JournalMedicine (United States)
Volume94
Issue number43
DOIs
Publication statusPublished - 2015

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Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Cohort Studies
Cardiovascular Diseases
Confidence Intervals
Population
Intention to Treat Analysis
Propensity Score
Hyperkalemia
National Health Programs
Aldosterone
Taiwan
Acute Kidney Injury
Renin
Heart Failure
Stroke
Myocardial Infarction
Databases
Survival
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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. / Chien, Shu Chen; Ou, Shuo Ming; Shih, Chia Jen; Chao, Pei Wen; Li, Szu Yuan; Lee, Yi Jung; Kuo, Shu Chen; Wang, Shuu Jiun; Chen, Tzeng Ji; Tarng, Der Cherng; Chu, Hsi; Chen, Yung Tai.

In: Medicine (United States), Vol. 94, No. 43, e1751, 2015.

Research output: Contribution to journalArticle

Chien, Shu Chen ; Ou, Shuo Ming ; Shih, Chia Jen ; Chao, Pei Wen ; Li, Szu Yuan ; Lee, Yi Jung ; Kuo, Shu Chen ; Wang, Shuu Jiun ; Chen, Tzeng Ji ; Tarng, Der Cherng ; Chu, Hsi ; Chen, Yung Tai. / 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. In: Medicine (United States). 2015 ; Vol. 94, No. 43.
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abstract = "Renin and aldosterone activity levels are low in elderly patients, raising concerns about the benefits and risks of angiotensinconvertingenzyme 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.",
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AU - Shih, Chia Jen

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AU - Kuo, Shu Chen

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AU - Chu, Hsi

AU - Chen, Yung Tai

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