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

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11 引文 斯高帕斯(Scopus)

摘要

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.
原文英語
文章編號e1751
期刊Medicine (United States)
94
發行號43
DOIs
出版狀態已發佈 - 2015

ASJC Scopus subject areas

  • 醫藥 (全部)

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