Antihypertensive medications and risk of community-acquired pneumonia.
OBJECTIVE
To determine whether angiotensin-converting enzyme (ACE) inhibitors and other antihypertensives are associated with risk of pneumonia.


METHODS
We conducted a nested case-control study of incident pneumonia in a subcohort of hypertensive adults insured by several large commercial plans throughout the United States. Individuals with pneumonia were matched on age, sex, region, and subscriber status with up to 10 controls free of pneumonia at the time of case diagnosis. We examined use of beta-blockers, calcium channel blockers, ACE inhibitors (lipophilic and hydrophilic), angiotensin receptor blockers, and thiazides in the prior 3 and 12 months.


RESULTS
A total of 7429 cases of pneumonia occurred among 305 958 hypertensive individuals. Risk of pneumonia was higher among users of beta-blockers [adjusted odds ratio (OR) 1.11; 95% confidence interval (CI) 1.03-1.19], calcium channel blockers (adjusted OR 1.09, 95% CI 1.00-1.17), and lipophilic ACE inhibitors (adjusted OR 1.15, 95% CI 1.03-1.28) in the preceding 3 months; risks were also higher for use in the preceding 12 months. We observed lower risk with thiazide use in the preceding 3 months (adjusted OR 0.90, 95% CI 0.81-0.99) and hydrophilic ACE inhibitor use in the preceding year (adjusted OR 0.86, 95% CI 0.75-0.99).


CONCLUSIONS
In this population of middle-aged Americans with hypertension, we observed a modestly higher risk of pneumonia with use of beta-blockers, calcium channel blockers, and lipophilic ACE inhibitors. These results are consistent with possible differences in noncardiovascular outcomes among users of antihypertensives and other commonly used cardiovascular drugs but require confirmation in other populations.
Mukamal
Kenneth J
KJ
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. kmukamal@bidmc.harvard.edu
Ghimire
Sanjay
S
Pandey
Rudra
R
O'Meara
Ellen S
ES
Gautam
Shiva
S
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000009:adverse effects*; D002121:Calcium Channel Blockers / Q000009:adverse effects; D016022:Case-Control Studies; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000209:etiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011014:Pneumonia / Q000209:etiology*; D012307:Risk Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000494:pharmacology; D014481:United States
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D049993:Sodium Chloride Symporter Inhibitors