College of Nursing, University of South Carolina, Columbia, South Carolina, USA.
Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University-Purdue University, Indianapolis, Indiana, USA.
J Am Geriatr Soc. 2023 Jun;71(6):1873-1880. doi: 10.1111/jgs.18285. Epub 2023 Mar 11.
Studies suggest Angiotensin-Converting Enzyme inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) may slow the decline of memory function in individuals with mild to moderate Alzheimer's disease by regulating migroglial activation and oxidative stress within the brain's reticular activating system. Therefore, we evaluated the relationship between delirium prevalence and being prescribed ACEI and ARB in participants admitted to the intensive care units (ICU).
A secondary analysis of data from two parallel pragmatic randomized controlled trials was performed. ACEI and ARB exposure was defined as being prescribed an ACEI or an ARB within six months prior to the ICU admission. The primary endpoint was the first positive delirium assessment based on Confusion Assessment Method for the ICU (CAM-ICU) for up to thirty days.
A total of 4791 patients admitted to the medical, surgical, and progressive ICU and screened for eligibility for the parent studies between February 2009 and January 2015 from two level 1 trauma and one safety net hospital in a large urban academic health system were included. Delirium rates in the ICU were not significantly different among participants with no exposure to ACEI/ARB (12.6%), or exposure to ACEI (14.4%), ARB (11.8%), or ACEI and ARB in combination (15.4%) in six months prior to the ICU admission. Exposure to ACEI (OR = 0.97[0.77, 1.22]), ARB (OR = 0.70 [0.47, 1.05]), or both (OR = 0.97 [0.33, 2.89]) in six months prior to ICU admission was not significantly associated with odds of delirium during the ICU admission after adjusting for age, gender, race, co-morbidities, and insurance status.
While the impact of ACEI and ARB exposure prior to the ICU admission was not associated with the prevalence of delirium in this study, further research is needed to fully understand the impact of antihypertensive medications on delirium.
研究表明，血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）通过调节大脑网状激活系统中的小胶质细胞激活和氧化应激，可能减缓轻度至中度阿尔茨海默病患者的记忆功能下降。因此，我们评估了入住重症监护病房（ICU）的患者中，谵妄患病率与 ACEI 和 ARB 处方之间的关系。
对两项平行的实用随机对照试验的数据进行了二次分析。ACEI 和 ARB 暴露的定义为在入住 ICU 前 6 个月内被处方 ACEI 或 ARB。主要终点是根据 ICU 意识模糊评估法（CAM-ICU）在 30 天内进行的首次阳性谵妄评估。
共有 4791 名患者于 2009 年 2 月至 2015 年 1 月期间入住一家大型城市学术医疗系统的内科、外科和进展性 ICU，并接受了父母研究的筛选，这些患者来自 1 家 1 级创伤中心和 1 家安全网医院。在 ICU 期间，无 ACEI/ARB 暴露（12.6%）、ACEI 暴露（14.4%）、ARB 暴露（11.8%）或 ACEI 和 ARB 联合暴露（15.4%）的患者的谵妄发生率无显著差异在入住 ICU 前 6 个月。在调整年龄、性别、种族、合并症和保险状况后，入住 ICU 前 6 个月内 ACEI（OR=0.97[0.77, 1.22]）、ARB（OR=0.70[0.47, 1.05]）或两者（OR=0.97[0.33, 2.89]）的暴露与 ICU 入住期间发生谵妄的几率无关。
尽管本研究中 ACEI 和 ARB 暴露与谵妄的患病率无关，但仍需要进一步研究以充分了解降压药物对谵妄的影响。
