Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Côte Sainte-Catherine, H-425.1, Montreal, QC, H3T 1E2, Canada.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
Drug Saf. 2022 Jan;45(1):65-74. doi: 10.1007/s40264-021-01128-1. Epub 2021 Oct 29.
There are conflicting reports on the effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on acute pancreatitis incidence.
The aim was to determine whether use of ACE inhibitors and ARBs is associated with the incidence of acute pancreatitis, compared with use of dihydropyridine calcium channel blockers (dCCBs).
We assembled two population-based, new-user, active comparator cohorts using the United Kingdom Clinical Practice Research Datalink linked to the Hospital Episode Statistics repository and Office for National Statistics from 1998 to 2018, with follow-up until 2019. The first cohort included 304,083 ACE inhibitor initiators and 194,431 dCCB initiators. The second cohort included 29,160 ARB initiators and 203,610 dCCB initiators. Cox proportional hazards models were fit to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of acute pancreatitis, comparing ACE inhibitors and ARBs, separately, with dCCBs. Models were weighted using standardized mortality ratio weights generated from calendar time-specific propensity scores.
ACE inhibitors were associated with an increased risk of acute pancreatitis, compared with dCCBs (64.3 vs 45.2 per 100,000 person-years, respectively; HR 1.45, 95% CI 1.15-1.83). The number needed to harm after 2 and 5 years of use was 2438 and 1019, respectively. In contrast, ARBs were not associated with an increased risk of acute pancreatitis, compared with dCCBs (40.1 vs 47.6 per 100,000 person-years, respectively; HR 0.88, 95% CI 0.60-1.31).
ACE inhibitors were associated with a modest increased risk of acute pancreatitis compared with dCCBs. This association should be balanced with the known clinical benefits of ACE inhibitors in hypertension management. In contrast, no association was observed with ARBs.
血管紧张素转换酶（ACE）抑制剂和血管紧张素 II 受体阻滞剂（ARB）对急性胰腺炎发病率的影响存在相互矛盾的报告。
目的是确定与使用二氢吡啶钙通道阻滞剂（dCCB）相比，使用 ACE 抑制剂和 ARB 是否与急性胰腺炎的发病率相关。
我们使用英国临床实践研究数据链接和国家统计局从 1998 年到 2018 年的医院事件统计数据库，以及到 2019 年的随访，组建了两个基于人群的新使用者、活性对照队列。第一个队列包括 304083 名 ACE 抑制剂起始者和 194431 名 dCCB 起始者。第二个队列包括 29160 名 ARB 起始者和 203610 名 dCCB 起始者。使用 Cox 比例风险模型估计急性胰腺炎的危险比（HR）及其 95%置信区间（CI），分别比较 ACE 抑制剂和 ARB 与 dCCB。使用来自日历时间特定倾向评分的标准化死亡率比权重对模型进行加权。
与 dCCB 相比，ACE 抑制剂与急性胰腺炎的风险增加相关（分别为 64.3 和 45.2 例/100000 人年；HR 1.45，95%CI 1.15-1.83）。使用 2 年和 5 年后需要治疗的人数分别为 2438 人和 1019 人。相比之下，ARB 与 dCCB 相比，与急性胰腺炎的风险增加无关（分别为 40.1 和 47.6 例/100000 人年；HR 0.88，95%CI 0.60-1.31）。
与 dCCB 相比，ACE 抑制剂与急性胰腺炎的风险略有增加。这种关联应与 ACE 抑制剂在高血压管理中的已知临床益处相平衡。相比之下，与 ARB 无关。
