Use of ACE inhibitors and risk of community-acquired pneumonia: a review.
BACKGROUND
The administration of angiotensin-converting enzyme (ACE) inhibitors has been suggested as an alternative strategy for lowering the risk of community-acquired pneumonia (CAP) in the elderly, especially in patients with neurological and cerebrovascular comorbidity.


METHODS
We critically examined the relevant data from studies regarding the impact of ACE inhibitors in lowering the risk of CAP and/or mortality due to CAP in the elderly. We searched PubMed, Cochrane Database, and references of initially retrieved articles, and http://clinicaltrials.gov for ongoing trials.


RESULTS
We identified 285 evaluable studies. Fourteen studies met the inclusion criteria and were evaluated further, of which seven were prospective studies, two randomized controlled trials, and five retrospective studies. Eight of ten studies including patients of Asian origin demonstrated a statistical significance in favor of ACE inhibitors. On the contrary, only one of five studies including patients of non-Asian origin demonstrated results in favor of ACE inhibitors.


CONCLUSIONS
The available data suggest that ACE inhibitors may contribute to the reduction of the risk of CAP. Nevertheless, clinical data are scarce and mainly comprise studies including patients of Asian origin. As there seem to be differences regarding the genetic polymorphism of ACE among patients of different origins, future studies are needed that incorporate relevant genetics data that may help clarify the role, if any, of ACE inhibitors in preventing CAP.
Rafailidis
Petros I
PI
Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, 151 23 Marousi, Greece.
Matthaiou
Dimitrios K
DK
Varbobitis
Ioannis
I
Falagas
Matthew E
ME
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000517:prevention & control*; D006801:Humans; D007703:Peptidyl-Dipeptidase A / Q000235:genetics; D011014:Pneumonia / Q000517:prevention & control*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012306:Risk
D000806:Angiotensin-Converting Enzyme Inhibitors; D007703:Peptidyl-Dipeptidase A