Angiotensin-converting enzyme inhibitor use and pneumonia risk in a general population

Abstract

The aim of the present study was to assess whether the use of angiotensinconverting enzyme (ACE) inhibitors is associated with a decreased risk of hospitalisation for community-acquired pneumonia (CAP) in a general, essentially white population.Data were obtained from the Dutch PHARMO Record Linkage System. Cases were defined as patients with a first hospital admission for CAP. For each case, up to four population controls were matched by age and sex.The study population comprised 1,108 patients with a first hospital admission for CAP and 3,817 matched controls. After adjusting for several confounders, ACE inhibitor use was not associated with a decreased incidence of pneumonia (adjusted odds ratio (OR) 1.12; 95% confidence interval (CI) 0.88-1.43). Additionally, no significant association was observed in patients with diabetes, respiratory diseases, heart failure, or patients with both of the last two conditions. Furthermore, adjustment of treatment effects on pneumonia risk using stratification on balancing score also showed no significant association between ACE inhibitor use and pneumonia risk within the different strata (overall adjusted OR 1.09; 95% CI 0.87-1.36).In contrast with previous findings in Asian populations, the current authors were not able to confirm the beneficial effect of angiotensin-converting enzyme inhibitors on pneumonia risk in a general, essentially white population.

Clinical features predicting failure of pathogen identification in patients with community acquired pneumonia

“…Finally, another possibility could be the effect of the use of antihypertensive medication, such as angiotensin converting enzyme (ACE) or angiotensin-II (ATII) inhibitors. Previous studies report ACE inhibitors as a risk factor for CAP [16,17], but this only explains the presence of patients with a medical history of hypertension in our group, but is still no explanation for the risk of failure of pathogen identification.…”

Angiotensin-converting enzyme inhibitor use and protection against pneumonia in patients with diabetes

“…In particular, heart failure is a strong reason for inpatient treatment in different prediction rule models and, subsequently, this could lead to an overestimation of ACE inhibitor use in identified admitted pneumonia cases versus population controls. This might explain why, in two previous case-control studies, no protective association between ACE inhibitor use and pneumonia was observed [32,33].…”

Angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers and pneumonia risk among stroke patients

“…However, four large-scale observational studies conducted in Caucasian populations showed inconsistent findings. Two population-based observational studies in the UK demonstrated the beneficial effect of ACEi use on pneumonia [16,17], whereas two observational studies in Canada and the Netherlands did not show these protective effects [18,19]. Several factors might be responsible for the inconsistent findings.…”