Impact of ACEIs and ARBs-related adverse drug reaction on patients’ clinical outcomes: a cohort study in UK primary care

Abstract

Background: Adverse drug reactions (ADRs)related to angiotensin-converting enzyme inhibitor(ACEI) and angiotensin receptor blocker(ARB) may negatively affect patients’ treatment outcomes. There is limited evidence on the impact of ADRs on patients’ outcome in real-world clinical setting. Aim: To investigate the impact of ACEI/ARB-related ADRs consultations in primary care on patients’ clinical outcomes. Design: Propensity score-matched cohort study of ACEI/ARB users during 2004-2019 using IQVIA medical research data. Methods: ACEI/ARB-related ADRs consultations were identified using standardised designated codes in primary care medical records data.Propensity scores were calculated based on comorbidities,concomitant medications,frailty index,polypharmacy,and interval between ACEI/ARB initiation and ADRs date.The outcomes of interest were cardiovascular disease (CVD) events and all-cause mortality.Cox proportional hazard regression models were used to compare the outcomes between ADRs and non-ADRs group. Results: Among 1,471,906 eligible ACEI/ARB users,13,652 patients(0.93%) had ACEI/ARB-related ADRs consultation in primary care. Mean follow-up duration were6.57and4.84years for the CVD primary(n=6,196) and secondary(n=14,238) prevention cohorts,respectively. ACEI/ARB-related ADRs were associated with CVD events and all-cause mortality in both primary(adjusted HR.1.22,95%CI1.05,1.43 and 1.14,95%CI1.01,1.27) and secondary prevention cohort (adjusted HR.1.13,95%CI1.05,1.21 and 1.15,95%CI1.09,1.21).Half (50.19%) patients with ADRs consultation continued to use ACEI/ARB and these patients had a reduced risk of mortality(adjusted HR.0.88,95%CI0.82,0.95) compared to those who discontinued ACEI/ARB. Conclusions: This study provides information on the burden of ADRs on patients and the health system. Patients with ACEI/ARB-related ADRs consultation had an increased risk of subsequent CVD events and mortality,indicating additional monitoring and treatment strategies by healthcare professionals for affected patients are needed to mitigate the risks of adverse clinical outcomes.

Prevalence of cardiovascular drug-related adverse drug reactions consultations in UK primary care: A cross-sectional study

“…A previous study showed that patients who received prior information on potential ADRs from their health care professionals were less likely to report drug complications and were more satisfied with their treatment [ 70 ]. In addition, it is recommended to implement more rigorous clinical and medication adherence monitoring for patients affected by ADRs as our previous studies showed that patients who experienced ADRs related to statins and ACEI/ARB had an increased risk of subsequent cardiovascular events compared to those who did not experience ADRs [ 7 , 8 ]. These previous studies are different with current study, as these studies are cohort studies investigating the subsequent treatment outcomes following the ADRs, while current study focused on the prevalence and risk factors of ADRs.…”

“…Cardiovascular drugs included were i) angiotensin- converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARBs), ii) calcium channel blockers (CCBs), iii) diuretics, iv) lipid regulating drugs, v) antiplatelets and anticoagulants vi) beta blockers, and vii) nitrates [ 22 ]. ADRs consultations related with cardiovascular drugs were identified using standardised designated codes in primary care records, which has been previously validated [ 7 , 8 , 18 , 23 ].…”

Recent Advances in the Therapeutic Potential of Carotenoids in Preventing and Managing Metabolic Disorders

“…In clinical practice, administering ARBs, ACE inhibitors, antidiabetic agents, GLP-1 receptor agonists, or SGLT2 inhibitors can lead to limitations and adverse effects (AEs) that may affect patients’ well-being and prognosis. Co-administration of ACE inhibitors and ARBs has been associated with major cardiovascular events, all-cause mortality, gastrointestinal disorders, hypotension, angioedema, and hyperkalemia [ 53 ]. Similarly, the administration of GPL-1 agonists like semaglutide has been linked to serious AEs such as vomiting, pancreatitis, and diarrhea, while liraglutide use has resulted in upper abdominal pain [ 54 ].…”

Efficacy and safety evaluation of Allisartan Isoproxil in patients with hypertension: a meta-analysis

“…Current hypertension management predominantly relies on a combination of antihypertensive medications and lifestyle modifications ( 16 ). Nevertheless, clinical challenges persist, including patient intolerance, adverse drug reactions, and insufficient control of blood pressure ( 17 – 20 ). The Renin-angiotensin-aldosterone system (RAAS) plays a crucial role in the pathogenesis of hypertension, prompting the latest guidelines to recommend angiotensin II receptor blockers (ARBs) as first-line therapy ( 21 , 22 ).…”