title: Preadmission use of ACE inhibitors or angiotensin receptor blockers and short-term mortality after stroke.
abstract: OBJECTIVE
  The prognostic impact of ACE inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) on stroke mortality remains unclear. We aimed to examine whether prestroke use of ACE-Is or ARBs was associated with improved short-term mortality following ischaemic stroke, intracerebral haemorrhage (ICH) and subarachnoid haemorrhage (SAH).
  
  
  METHODS
  We conducted a nationwide population-based cohort study using medical registries in Denmark. We identified all first-time stroke patients during 2004-2012 and their comorbidities. We defined ACE-I/ARB use as current use (last prescription redemption <90 days before admission for stroke), former use and non-use. Current use was further classified as new or long-term use. We used Cox regression modelling to compute 30-day mortality rate ratios (MRRs) with 95% CIs, controlling for potential confounders.
  
  
  RESULTS
  We identified 100 043 patients with a first-time stroke. Of these, 83 736 patients had ischaemic stroke, 11 779 had ICH, and 4528 had SAH. For ischaemic stroke, the adjusted 30-day MRR was reduced in current users compared with non-users (0.85, 95% CI 0.81 to 0.89). There was no reduction in the adjusted 30-day MRR for ICH (0.95, 95% CI 0.87 to 1.03) or SAH (1.01, 95% CI 0.84 to 1.21), comparing current users with non-users. No association with mortality was found among former users compared with non-users. No notable modification of the association was observed within sex or age strata.
  
  
  CONCLUSIONS
  Current use of ACE-Is/ARBs was associated with reduced 30-day mortality among patients with ischaemic stroke. We found no association among patients with ICH or SAH.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Sundbøll
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: E
authors.initials: E
authors.lastname: Horváth-Puhó
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: C F
authors.initials: CF
authors.lastname: Christiansen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Pedersen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: H E
authors.initials: HE
authors.lastname: Bøtker
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: H T
authors.initials: HT
authors.lastname: Sørensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000401:mortality; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D013345:Subarachnoid Hemorrhage / Q000401:mortality
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: CEREBROVASCULAR DISEASE; STROKE; SUBARACHNOID HAEMORRHAGE