Pei-Ying Pai1, Chih-Hsin Muo2, Fung-Chang Sung3, Hung-Chi Ho4, Yuan-Teh Lee5. 1. Division of Cardiovascular Medicine and General Medicine, China Medical University Hospital, Department of Internal Medicine, Taichung 404, Taiwan. 2. China Medical University Hospital, Management Office for Health Data, Taichung 404, Taiwan. 3. China Medical University Hospital, Management Office for Health Data, Taichung 404, Taiwan; China Medical University, Department of Public Health, Taichung 404, Taiwan. 4. Division of Cardiovascular Medicine, China Medical University Hospital, Department of Internal Medicine, Taichung 404, Taiwan. Electronic address: hohc15@gmail.com. 5. Division of Cardiovascular Medicine, China Medical University Hospital, Department of Internal Medicine, Taichung 404, Taiwan. Electronic address: ytlee@ntu.edu.tw.
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 18years 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 1000person-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 1000person-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.
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 18years 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 1000person-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 1000person-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.
Authors: Ivan T Lee; Tsuguhisa Nakayama; Chien-Ting Wu; Yury Goltsev; Sizun Jiang; Phillip A Gall; Chun-Kang Liao; Liang-Chun Shih; Christian M Schürch; David R McIlwain; Pauline Chu; Nicole A Borchard; David Zarabanda; Sachi S Dholakia; Angela Yang; Dayoung Kim; Tomoharu Kanie; Chia-Der Lin; Ming-Hsui Tsai; Katie M Phillips; Raymond Kim; Jonathan B Overdevest; Matthew A Tyler; Carol H Yan; Chih-Feng Lin; Yi-Tsen Lin; Da-Tian Bau; Gregory J Tsay; Zara M Patel; Yung-An Tsou; Chih-Jaan Tai; Te-Huei Yeh; Peter H Hwang; Garry P Nolan; Jayakar V Nayak; Peter K Jackson Journal: medRxiv Date: 2020-05-12
Authors: Ivan T Lee; Tsuguhisa Nakayama; Chien-Ting Wu; Yury Goltsev; Sizun Jiang; Phillip A Gall; Chun-Kang Liao; Liang-Chun Shih; Christian M Schürch; David R McIlwain; Pauline Chu; Nicole A Borchard; David Zarabanda; Sachi S Dholakia; Angela Yang; Dayoung Kim; Han Chen; Tomoharu Kanie; Chia-Der Lin; Ming-Hsui Tsai; Katie M Phillips; Raymond Kim; Jonathan B Overdevest; Matthew A Tyler; Carol H Yan; Chih-Feng Lin; Yi-Tsen Lin; Da-Tian Bau; Gregory J Tsay; Zara M Patel; Yung-An Tsou; Alexandar Tzankov; Matthias S Matter; Chih-Jaan Tai; Te-Huei Yeh; Peter H Hwang; Garry P Nolan; Jayakar V Nayak; Peter K Jackson Journal: Nat Commun Date: 2020-10-28 Impact factor: 14.919