Angiotensin receptor blockers (ARB) outperform angiotensin-converting enzyme (ACE) inhibitors on ischemic stroke prevention in patients with hypertension and diabetes — A real-world population study in Taiwan. (15th July 2016)

• Record Type: Journal Article
• Authors: Pai, Pei-Ying; Muo, Chih-Hsin; Sung, Fung-Chang; Ho, Hung-Chi; Lee, Yuan-Teh
• Is Part Of: International journal of cardiology. Volume 215(2016)
• Page Start: 114
• Page End: 119
• Publication Date: 2016-07-15
• Subjects: RAAS -- Stroke prevention -- CV risk; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.04.096
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Combination therapy with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) has been stressed for its comprehensive blocking of the renin-angiotensin-aldosterone system, but the evidence for their respective safety and efficacy, in particular with stroke prevention, is still insufficient in population-based follow-up studies in the real world. Methods: Using Taiwan's National Health Insurance claims data, we identified 5445 subjects aged 18 years and older who had newly diagnosed hypertension in 1997–2010, from them diagnosed type 2 diabetes later. Among them, 2161 patients took ACEI, 1703 patients took ARB, 165 patients took both ACEI and ARB, and 1416 patients had neither. Results: During the follow-up period, the stroke incidence density was the lowest (23.02 per 1000 person-years) in ARB group, followed by the group with neither medication, the ACEI group, and ARB/ACEI combination group (24.06, 30.23, and 37.86 per 1000 person-years, respectively). Compared with patients taking neither medication, the adjusted hazard ratios (HRs) were 1.27 (95% CI 1.02–1.58) for ACEI group, 0.95 (95% CI 0.74–1.22) for ARB group, and 1.56 (95% CI 0.99–2.47) for ARB/ACEI combined group. Greater reduction in risk of stroke was observed in patients with high dose ARB (adjusted HR = 0·42, 95% CI 0·24–0·75). Conclusion: Our findings support the practice that ARBs could be used, from the perspective of stroke prevention, as a first-line antihypertensive drug for patients with both hypertension and diabetes. The group with ARB regimen reduces 26% of stroke in contrast to the group with ACEI regimen.