Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom; Health Data Research (HDR)-UK; Department of Public Health, University of Southern Denmark, Denmark.
Scottish Centre for Respiratory Research, University of Dundee, Dundee, United Kingdom.
J Allergy Clin Immunol Pract. 2021 Sep;9(9):3431-3439.e4. doi: 10.1016/j.jaip.2021.04.055. Epub 2021 May 6.
Angiotensin converting enzyme inhibitor (ACEI) intolerance commonly occurs, requiring switching to an angiotensin-II receptor blocker (ARB). Angiotensin converting enzyme inhibitor intolerance may be mediated by bradykinin, potentially affecting airway hyperresponsiveness.
To assess the risk for switching to ARBs in asthma.
We conducted a new-user cohort study of ACEI initiators identified from electronic health records from the UK Clinical Practice Research Datalink. The risk for switching to ARBs in people with asthma or chronic obstructive pulmonary disease and the general population was compared. Adjusted hazard ratios (HRs) were calculated using Cox regression, stratified by British Thoracic Society (BTS) treatment step and ACEI type.
Of 642,336 new users of ACEI, 6.4% had active asthma. The hazard of switching to ARB was greater in people with asthma (HR = 1.16; 95% confidence interval [CI], 1.14-1.18; P ≤ .001) and highest in those at BTS step 3 or greater (HR = 1.35, 95% CI, 1.32-1.39; and HR = 1.18, 95% CI, 1.15-1.22, P ≤ .001 for patients aged ≥60 and <60 years, respectively). Hazard was highest with enalapril (HR = 1.25, 95% CI, 1.18-1.34, P ≤ .001; HR = 1.44, 95% CI, 1.32-1.58, P ≤ .001 for BTS step 3 or greater asthma). No increased hazard was observed in chronic obstructive pulmonary disease or those younger than age 60 years at BTS step 1/2. The number needed to treat varied by age, sex, and body mass index (BMI), ranging between 21 and 4, and was lowest in older women with a BMI of 25 or greater.
People with active asthma are more likely to switch to ARBs after commencing ACEI therapy. The number needed to treat varies by age, sex, BMI, and BTS step. Angiotensin-II receptor blocker could potentially be considered first-line in people with asthma and in those with high-risk characteristics.
血管紧张素转换酶抑制剂（ACEI）不耐受很常见，需要转换为血管紧张素-II 受体阻滞剂（ARB）。ACEI 不耐受可能由缓激肽介导，可能会影响气道高反应性。
评估哮喘患者转换为 ARB 的风险。
我们从英国临床实践研究数据链接的电子健康记录中对 ACEI 新使用者进行了一项新使用者队列研究。比较了 ACEI 新使用者中哮喘或慢性阻塞性肺疾病患者与普通人群转换为 ARB 的风险。使用 Cox 回归计算调整后的风险比（HR），并按英国胸科学会（BTS）治疗步骤和 ACEI 类型分层。
在 642336 例 ACEI 新使用者中，6.4%有活动性哮喘。哮喘患者转换为 ARB 的风险更高（HR=1.16；95%置信区间[CI]，1.14-1.18；P≤.001），BTS 步骤 3 或更高的患者风险最高（HR=1.35，95%CI，1.32-1.39；HR=1.18，95%CI，1.15-1.22，P≤.001 年龄≥60 岁和<60 岁的患者）。依那普利的风险最高（HR=1.25，95%CI，1.18-1.34，P≤.001；HR=1.44，95%CI，1.32-1.58，P≤.001 用于 BTS 步骤 3 或更高的哮喘）。在慢性阻塞性肺疾病或 BTS 步骤 1/2 年龄<60 岁的患者中，未观察到危险增加。治疗人数因年龄、性别和体重指数（BMI）而异，范围为 21 至 4，在年龄较大、BMI 为 25 或更高的女性中最低。
在开始 ACEI 治疗后，有活动性哮喘的患者更有可能转换为 ARB。治疗人数因年龄、性别、BMI 和 BTS 步骤而异。在哮喘患者和高危特征患者中，ARB 可能被认为是一线治疗药物。
