title: Post-stroke pneumonia prevention by angiotensin-converting enzyme inhibitors: results of a meta-analysis of five studies in Asians.
abstract: BACKGROUND
  Angiotensin-converting enzyme inhibitors (ACEIs) are reported to reduce the incidence of aspiration pneumonia in hypertensive patients. In this study, a metaanalysis was conducted to obtain statistically more reliable estimates of outcome.
  
  
  METHODS
  The MEDLINE and JMEDICINE databases were searched and the following study selection criteria were applied: (1) comparative controlled studies identified with the following keywords: drug therapy, ACEI, hypertension, swallowing function, dysphagia, stroke, and pneumonia; (2) a minimum follow-up period of 6 months; and (3) a minimum number of patients of more than 100. Patients with hypertension and a history of stroke or transient ischemic attack (TIA) in five controlled studies that reported the incidence of pneumonia were included in the analysis.
  
  
  RESULTS
  A total of 8,693 post-stroke patients were given ACEIs with another antihypertensive agent or placebo as a control. In all studies, ACEIs, particularly imidapril, exhibited preventive effects equating to a relative risk that ranged from 0.32 to 0.81 compared with controls. In the combined studies the overall relative risk of ACEI-treated patients versus controls was 0.61 (95% confidence intervals [CI] 0.51-0.75; P < 0.001). Among Asian patients, the relative risk was 0.42 (95% CI 0.32-0.56; P < 0.001). Among Japanese patients, an even greater preventive effect was found for ACEIs versus other antihypertensives (relative risk: 0.38 [95% CI 0.27-0.54; P < 0.001]).
  
  
  CONCLUSIONS
  ACEIs appear to be more effective than other antihypertensive agents or placebo in reducing pneumonia risk in post-stroke patients, especially in Asian populations.
authors.affiliation: Department of Neurology, Federation of National Personnel Mutual Aid Associations Tachikawa Hospital, 4-2-22 Nishikicho, Tachikawa, Tokyo, 190-8531, Japan. yshinoha@tachikawa-hosp.gr.jp
authors.forename: Yukito
authors.initials: Y
authors.lastname: Shinohara
authors.forename: Hideki
authors.initials: H
authors.lastname: Origasa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044466:Asian People; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D011015:Pneumonia, Aspiration / Q000150:complications / Q000208:ethnology / Q000517:prevention & control*; D020521:Stroke / Q000150:complications* / Q000208:ethnology; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents