N J Brown1, M Snowden, M R Griffin. 1. Department of Medicine, Vanderbilt University, Nashville, Tenn 37232-6602, USA. nancy.brown@mcmail.vanderbilt.edu
Abstract
CONTEXT: Angiotensin-converting enzyme (ACE) inhibitors are associated with an increased risk of angioedema, but the risk of recurrent angioedema if treatment is continued is not known. OBJECTIVE: To test the hypothesis that the association between ACE inhibitor use and angioedema may not be recognized and to determine characteristics of angioedema associated with continued use of ACE inhibitors. DESIGN: Retrospective cohort study. SETTING: Tennessee Medicaid program. PATIENTS: Medicaid enrollees aged 15 years or older who used an ACE inhibitor and had a first documented episode of angioedema between 1986 and 1992 were followed up for recurrent episodes through June 1993. MEASUREMENTS AND MAIN RESULTS: We previously identified 82 patients with a first confirmed diagnosis of angioedema during 51 752 person-years of ACE inhibitor use in this population (1.6 per 1000 person-years). Among these 82 patients, there were 16 outpatient recurrences of angioedema among 13 patients during 189 patient-years of follow-up (8.5 per 100 patient-years). The rate of angioedema was much higher in users of ACE inhibitors with continued exposure (18.7 per 100 patient-years) than in those whose use of the drug was discontinued (1.8 per 100 patient-years) (P=.001). Review of the medical records for patients taking ACE inhibitors who had recurrent angioedema revealed that physicians attributed angioedema to a number of causes not related to ACE inhibitor use, even after multiple recurrences. CONCLUSION: Continuing use of ACE inhibitors in spite of angioedema results in a markedly increased rate of angioedema recurrence with serious morbidity.
CONTEXT: Angiotensin-converting enzyme (ACE) inhibitors are associated with an increased risk of angioedema, but the risk of recurrent angioedema if treatment is continued is not known. OBJECTIVE: To test the hypothesis that the association between ACE inhibitor use and angioedema may not be recognized and to determine characteristics of angioedema associated with continued use of ACE inhibitors. DESIGN: Retrospective cohort study. SETTING: Tennessee Medicaid program. PATIENTS: Medicaid enrollees aged 15 years or older who used an ACE inhibitor and had a first documented episode of angioedema between 1986 and 1992 were followed up for recurrent episodes through June 1993. MEASUREMENTS AND MAIN RESULTS: We previously identified 82 patients with a first confirmed diagnosis of angioedema during 51 752 person-years of ACE inhibitor use in this population (1.6 per 1000 person-years). Among these 82 patients, there were 16 outpatient recurrences of angioedema among 13 patients during 189 patient-years of follow-up (8.5 per 100 patient-years). The rate of angioedema was much higher in users of ACE inhibitors with continued exposure (18.7 per 100 patient-years) than in those whose use of the drug was discontinued (1.8 per 100 patient-years) (P=.001). Review of the medical records for patients taking ACE inhibitors who had recurrent angioedema revealed that physicians attributed angioedema to a number of causes not related to ACE inhibitor use, even after multiple recurrences. CONCLUSION: Continuing use of ACE inhibitors in spite of angioedema results in a markedly increased rate of angioedema recurrence with serious morbidity.
Authors: Brittany Straka; Hui Nian; Chantel Sloan; James Brian Byrd; Alencia Woodard-Grice; Chang Yu; Elizabeth Stone; Gary Steven; Tina Hartert; Koon K Teo; Guillaume Pare; Catherine A McCarty; Nancy J Brown Journal: J Allergy Clin Immunol Pract Date: 2013-06-21
Authors: James Brian Byrd; Karine Touzin; Saba Sile; James V Gainer; Chang Yu; John Nadeau; Albert Adam; Nancy J Brown Journal: Hypertension Date: 2007-11-19 Impact factor: 10.190