title: Use of ACE inhibitors and risk of community-acquired pneumonia: a review.
abstract: 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.
authors.affiliation: Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, 151 23 Marousi, Greece.
authors.forename: Petros I
authors.initials: PI
authors.lastname: Rafailidis
authors.forename: Dimitrios K
authors.initials: DK
authors.lastname: Matthaiou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Varbobitis
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Falagas
mesh_terms: 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
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D007703:Peptidyl-Dipeptidase A