Chang Chia-Hsuin, Lin Jou-Wei, Ruan Sheng-Yuan, Lee Yen-Chieh, Wu Li-Chiu, Lin Min-Shung, Lai Mei-Shu
aInstitute of Preventive Medicine, College of Public Health, National Taiwan University bDepartment of Internal Medicine, National Taiwan University Hospital cDepartment of Medicine, College of Medicine, National Taiwan University dCardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County eDepartment of Family Medicine, Cathay General Hospital, Taipei, Taiwan.
J Hypertens. 2015 Mar;33(3):634-42; discussion 642-3. doi: 10.1097/HJH.0000000000000438.
Angiotensin-converting enzyme (ACE) inhibitors might decrease the risk of pneumonia, but head-to-head comparisons with angiotensin receptor blockers (ARBs) were seldom made. The objective of this study was to evaluate incidence of pneumonia and mortality for different ACE inhibitors as compared to losartan, an ARB that has similar indications.
Adult patients aged more than 20 years who initiated ACE inhibitors and losartan between 1 January 2004 and 31 December 2009 were identified from Taiwan's National Health Insurance Database. The outcomes of interest were hospitalization for pneumonia and pneumonia-related mortality. Participants were followed from treatment initiation to the earliest of outcome occurrence, death or disenrollment, treatment discontinuation, switching to other ACE inhibitors or ARBs, or study termination (31 December 31 2010). Proportional-hazards regression model was used to calculate the hazard ratios and their 95% confidence intervals (CIs), adjusted on baseline characteristics.
A total of 1,192,082 ACE inhibitors and 175,668 losartan initiators were included. The risk of hospitalization for pneumonia was significantly higher for captopril (hazard ratio 1.94, 95% CI 1.82-2.07), enalapril (hazard ratio 1.14, 95% CI 1.07-1.22), fosinopril (hazard ratio 1.11, 95% CI 1.02-1.21), perindopril (hazard ratio 1.14, 95% CI 1.04-1.25), and ramipril (hazard ratio 1.11, 95% CI 1.02-1.22), as compared with losartan. Captopril was associated with a significantly increased risk of pneumonia mortality (hazard ratio 2.43, 95% CI 1.79-3.31).
Treatment with ACE inhibitors is not associated with a lower risk of pneumonia incidence and mortality as compared with losartan.
血管紧张素转换酶（ACE）抑制剂可能会降低肺炎风险，但很少与血管紧张素受体阻滞剂（ARB）进行直接比较。本研究的目的是评估不同ACE抑制剂与具有相似适应症的ARB氯沙坦相比的肺炎发病率和死亡率。
从台湾国民健康保险数据库中识别出2004年1月1日至2009年12月31日期间开始使用ACE抑制剂和氯沙坦的20岁以上成年患者。感兴趣的结局是因肺炎住院和肺炎相关死亡率。参与者从治疗开始随访至最早出现结局、死亡或退出、治疗中断、改用其他ACE抑制剂或ARB或研究终止（2010年12月31日）。使用比例风险回归模型计算风险比及其95%置信区间（CI），并根据基线特征进行调整。
共纳入1,192,082名ACE抑制剂使用者和175,668名氯沙坦使用者。与氯沙坦相比，卡托普利（风险比1.94，95%CI 1.82-2.07）、依那普利（风险比1.14，95%CI 1.07-1.22）、福辛普利（风险比1.11，95%CI 1.02-1.21）、培哚普利（风险比1.14，95%CI 1.04-1.25）和雷米普利（风险比1.11，95%CI 1.02-1.22）因肺炎住院的风险显著更高。卡托普利与肺炎死亡率显著增加相关（风险比2.43，95%CI 1.79-3.31）。
与氯沙坦相比，使用ACE抑制剂治疗与肺炎发病率和死亡率较低的风险无关。
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