ARB users exhibit a lower fracture incidence than ACE inhibitor users among older hypertensive men

Kwok, Tsz-Ho; Leung, Jason; Barrett‐Connor, Elizabeth

doi:10.1093/ageing/afw150

Cited by 25 publications

(29 citation statements)

References 28 publications

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“…Among numerous drugs used for HPI-related diseases many are well known to contribute to OP/OFs. In regard to OP, these include corticosteroids, antidepressants (especially, selective serotonin- and serotonin-norepinephrine reuptake inhibitors), glitazones, opioids, benzodiazepines, antipsychotics, antiparkinsonian drugs, antiepileptics, PPIs, H2RA, thyroxine, furosemide, aromatase inhibitors, gonadotropin releasing hormone (GnRH) agonists, whereas hormone replacement therapy with estrogen, thiazides, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), spironolactone, beta-blockers, statins, antihistamines, metformin, sulphonylureas, glucagon-like peptide-1 receptor agonists (liraglutide) and nitrates have shown an osteoprotective effect [ 316 , 521 , 522 , 523 , 524 , 525 , 526 , 527 , 528 , 529 , 530 , 531 , 532 , 533 , 534 , 535 , 536 , 537 , 538 , 539 , 540 , 541 , 542 , 543 , 544 , 545 , 546 , 547 , 548 , 549 , 550 , 551 , 552 , 553 , 554 ].…”

Section: Hpi-associated Chronic Extra-gastroduodenal Diseases Medmentioning

confidence: 99%

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Fisher

Smith

2020

JCM

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Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world’s population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI–OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.

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Section: Hpi-associated Chronic Extra-gastroduodenal Diseases Medmentioning

confidence: 99%

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Fisher

Smith

2020

JCM

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“…An alternate explanation would be an improper selection of a priori falsification endpoints given limited studies suggesting lower risk of fracture with ARB than ACEI therapy. 58 However, this has not been seen with UTIs.…”

Section: Discussionmentioning

confidence: 99%

Renin–angiotensin–aldosterone system inhibitors and SARS-CoV-2 infection: an analysis from the veteran's affairs healthcare system

Sandhu

Kohsaka

Lin

et al. 2021

American Heart Journal

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Background: Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are known to impact the functional receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The association between chronic therapy with these medications and infection risk remains unclear. Objectives: The objective was to determine the association between prior ACEI or ARB therapy and SARS-CoV-2 infection among patients with hypertension in the U.S. Veteran's Affairs health system. Methods: We compared the odds of SARS-CoV-2 infection among three groups: patients treated with ACEI, treated with ARB, or treated with alternate first-line anti-hypertensives without ACEI/ARB. We excluded patients with alternate indications for ACEI or ARB therapy. We performed an augmented inverse propensity weighted analysis with adjustment for demographics, region, comorbidities, vitals, and laboratory values. Results: Among 1,724,723 patients with treated hypertension, 659,180 were treated with ACEI, 310,651 with ARB, and 754,892 with neither. Before weighting, patients treated with ACEI or ARB were more likely to be diabetic and use more anti-hypertensives. There were 13,278 SARS-CoV-2 infections (0.8%) between February 12, 2020 and August 19, 2020. Patients treated with ACEI had lower odds of SARS-CoV-2 infection (odds ratio [OR] 0.93; 95% CI: 0.89-0.97) while those treated with ARB had similar odds (OR 1.02; 95% CI: 0.96-1.07) compared with patients treated with alternate first-line anti-hypertensives without ACEI/ARB. In falsification analyses, patients on ACEI did not have a difference in their odds of unrelated outcomes. Conclusions: Our results suggest the safety of continuing ACEI and ARB therapy. The association between ACEI therapy and lower odds of SARS-CoV-2 infection requires further investigation.

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“…Ruths et al in their large cohort study in Norway showed that all kinds of hypertension medication may prevent hip fracture except loop diuretics and ACEI in patients older than 80s. And another cohort study in the United States by Kwok et al, [ 34 ] on older hypertensive men reported that ARB users had lower risk of fracture than ACEI users.…”

Section: Discussionmentioning

confidence: 99%

Association between renin–angiotensin–aldosterone system blockade and future osteoporotic fracture risk in hypertensive population

et al. 2017

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Tissue renin–angiotensin–aldosterone system (RAAS) activation in sites of osteoporosis had been demonstrated in animal studies; however, the possibility of RAAS blockade to prevent future osteoporotic fracture had rarely been verified in clinical studies. We Used the Taiwan Longitudinal Health insurance database 2000 to 2008, the cohort study comprised patients age over 40 with a recorded new diagnosis of hypertension between January 1, 2000 to December 31, 2008, in addition, patients who had diagnosis of osteoporosis before the date of cohort enter were excluded. After the definite diagnosis of hypertension, each patient was followed until osteoporotic fracture happened or the end of 2008. The occurrence of osteoporotic fracture was evaluated in patients who either were or without taking RAAS blockade agents. Cox proportional hazard regressions were used to evaluate the osteoporotic fracture incidence after adjusting for known confounding factors. In total, 57,132 hypertensive patients comprised the study cohort. Our study results showed that the incidence of osteoporosis fracture in the whole cohort was significantly higher in the RAAS blockade non-user group than the user group. This phenomenon was observed in both sex and all age categories. Sensitivity analysis further showed the concordant lower osteoporosis fracture risk in patients with various RAAS blockers usage durations; the risk of osteoporosis fracture was the lowest in those drug use >365 days when compared with the non-user cohort. In conclusion, our study result demonstrated the lower future osteoporotic fracture risk in hypertensive subjects who received long term RAAS blocker treatment.

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ARB users exhibit a lower fracture incidence than ACE inhibitor users among older hypertensive men

Abstract: In older hypertensive men, ARBs use was associated with lower incidence of non-vertebral fracture than ACE inhibitors or CCBs.

Cited by 25 publications

References 28 publications

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Renin–angiotensin–aldosterone system inhibitors and SARS-CoV-2 infection: an analysis from the veteran's affairs healthcare system

Association between renin–angiotensin–aldosterone system blockade and future osteoporotic fracture risk in hypertensive population

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