Meta-Analysis of Randomized Trials on the Efficacy and Safety of Angiotensin-Converting Enzyme Inhibitors in Patients ≥65 Years of Age

Bavishi, Chirag; Ahmed, Mohammed; Trivedi, Vrinda; Khan, Abdur Rahman; Góngora, Carlos; Bangalore, Sripal; Messerli, Franz H.

doi:10.1016/j.amjcard.2016.07.074

Cited by 13 publications

(6 citation statements)

References 40 publications

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“…99 We have furthermore recently proposed that in patients >80 years, ACE inhibitors should be among the first line medications because these represented 1 of the 2 drug classes used in HYVET. 115 However, the findings of some clinical studies argue against the use of ACE inhibitor as the first choice in older adults 116 and propose replacing them by ARBs. 117 It is important to regularly check for all potential clinical and biological side effects and the impact of these treatments on the functional status and quality of life of the older patients.…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

Hypertension Management in Older and Frail Older Patients

Bénétos

Petrovic

Strandberg

2019

Circulation Research

313

190

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The prevalence of arterial hypertension, particularly systolic hypertension, is constantly rising worldwide. This is mainly the clinical expression of arterial stiffening as a result of the population's aging. Chronic elevation in blood pressure represents a major risk factor not only for cardiovascular morbidity and mortality but also for cognitive decline and loss of autonomy later in life. Clinical evidence obtained in community-dwelling older people with few comorbidities and preserved autonomy supports the beneficial effects of lowering blood pressure in older hypertensive subjects even after the age of 80 years. However, observational studies in frail older individuals treated for hypertension have shown higher morbidity and mortality rates compared with those with lower blood pressure levels. Clearly, in very old subjects, the therapeutic strategy of one size fits all cannot be applied because of the enormous functional heterogeneity in these individuals. Geriatric medicine proposes taking into account the function/frailty/autonomy status of older people. In the present review, we propose to adapt the antihypertensive treatment using an easy-to-apply visual numeric scale allowing the identification of 3 different patient profiles according to the functional status and autonomy for activities of daily living. For the preserved function profile, strategies should be those proposed for younger old adults. For the loss of function/preserved activities of daily living' profile, a more detailed geriatric assessment is needed to define the benefit/risk balance as well as requirements for the tailoring of the various therapeutic strategies. Lastly, for the loss of function and altered activities of daily living' profile, therapeutic strategies should be thoroughly reassessed, including deprescribing (when considered appropriate). In the near future, controlled trials are necessary for the most frail older subjects (ie, in those systematically excluded from previous clinical trials) to gain stronger evidence regarding the benefits of the various therapeutic strategies.

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Section: Therapeutic Strategiesmentioning

confidence: 99%

Hypertension Management in Older and Frail Older Patients

Bénétos

Petrovic

Strandberg

2019

Circulation Research

313

190

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“…Of the 112 patients, 71 were treated with an ACEI alone . Likewise, a meta‐analysis of 16 randomized trials of ACEIs' safety and efficacy in patients 65 years and older documented a 2.8‐fold increase in risk of angioedema by ACEIs compared with active controls . Data from a National Health and Nutrition Examination Survey show that in the past decade, one third of antihypertensive prescriptions in the United States were for ACEIs .…”

Section: Introductionmentioning

confidence: 99%

Angiotensin‐converting enzyme inhibitor–induced angioedema: A review of the literature

Brown

Gonzalez

Monteleone

2017

J of Clinical Hypertension

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According to the National Health and Nutrition Examination Survey 2012, one third of antihypertensive prescriptions in the United States in the past decade were for angiotensin-converting enzyme inhibitors (ACEIs). An important and serious side effect of ACEIs is angioedema caused by a reduction in bradykinin degradation. In a national medical chart abstraction study conducted at the US Veterans Affairs Health Care System in 2008, 0.20% of ACEI initiators developed angioedema while on the medication. The angiotensin-converting enzyme is a part of the renin-angiotensin system that converts angiotensin I to angiotensin II. It is additionally responsible for the degradation of bradykinin, which is generated from high molecular weight kininogen by kallikrein. Via bradykinin 2 receptors, bradykinin affects vascular permeability and stimulates the release of substance P, which is a peptide that causes vasodilation and fluid extravasation into tissues. Inhibition of the angiotensin-converting enzyme and subsequent blockade of bradykinin degradation is thought to be a likely explanation for ACEI-induced angioedema. Studies have shown that blacks, women, and smokers are at an increased risk for ACEI-induced angioedema. A 2005 study identified black race, history of drug rash, age older than 65 years, and seasonal allergies as independent risk factors for angioedema related to enalapril. Angioedema may occur at any time during treatment with ACEIs and may continue after the medication is discontinued. The degree of ACEI-angiotensin receptor blocker angioedema cross-reactivity is difficult to determine from the literature. However, multiple studies have reported relatively low rates of native angioedema with angiotensin receptor blockers (approximately half that of ACEIs, or 0.1%) and a low incidence of cross-reactivity (<10%).Common treatments for angioedema, such as antihistamines and glucocorticoids, have not been shown to be effective in ACEI-induced angioedema. However, medications that have been used for acute treatment of hereditary angioedema and target the factors that cause ACEI-mediated angioedema are being explored.

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“…The ACE-I 36 should be discontinued 36 h before introducing the sacubitril/valsartan combination the dose titrated according to blood pressure tolerance, renal function and serum potassium should be monitored [6,22]. No RCTs have been conducted in the elderly HF population but all RCTs conducted in HFrEF patients have shown the beneficial effects of ACE-I/ARBs [62], BBs [63], MRAs [64] and sacubitril/valsartan [65].…”

Section: Hf Managementmentioning

confidence: 99%

Diagnosis and Management of Heart Failure in Elderly Patients from Hospital Admission to Discharge: Position Paper

Damy¹,

Chouihed

Delarche

et al. 2021

JCM

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Multidisciplinary management of worsening heart failure (HF) in the elderly improves survival. To ensure patients have access to adequate care, the current HF and French health authority guidelines advise establishing a clearly defined HF patient pathway. This pathway involves coordinating multiple disciplines to manage decompensating HF. Yet, recent registry data indicate that insufficient numbers of patients receive specialised cardiology care, which increases the risk of rehospitalisation and mortality. The patient pathway in France involves three key stages: presentation with decompensated HF, stabilisation within a hospital setting and transitional care back out into the community. In each of these three phases, HF diagnosis, severity and precipitating factors need to be promptly identified and managed. This is particularly pertinent in older, frail patients who may present with atypical symptoms or coexisting comorbidities and for whom geriatric evaluation may be needed or specific geriatric syndrome management implemented. In the transition phase, multi-professional post-discharge management must be coordinated with community health care professionals. When the patient is discharged, HF medication must be optimised, and patients educated about self-care and monitoring symptoms. This review provides practical guidance to clinicians managing worsening HF in the elderly.

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Meta-Analysis of Randomized Trials on the Efficacy and Safety of Angiotensin-Converting Enzyme Inhibitors in Patients ≥65 Years of Age

Cited by 13 publications

References 40 publications

Hypertension Management in Older and Frail Older Patients

Hypertension Management in Older and Frail Older Patients

Angiotensin‐converting enzyme inhibitor–induced angioedema: A review of the literature

Diagnosis and Management of Heart Failure in Elderly Patients from Hospital Admission to Discharge: Position Paper

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