title: Does Low Dose Angiotensin Converting Enzyme Inhibitor Prevent Pneumonia in Older People With Neurologic Dysphagia--A Randomized Placebo-Controlled Trial.
abstract: OBJECTIVE
  To examine if angiotensin converting enzyme inhibitor reduces the risk of pneumonia in older patients on tube-feeding because of dysphagia from cerebrovascular diseases.
  
  
  METHODS
  Randomized placebo-controlled trial.
  
  
  METHODS
  Acute and subacute geriatrics units, speech therapists' clinic, and nursing home.
  
  
  METHODS
  Older patients on tube-feeding for >2 weeks because of dysphagia secondary to cerebrovascular diseases.
  
  
  METHODS
  Participants were randomized to lisinopril 2.5 mg or placebo once daily for 26 weeks.
  
  
  METHODS
  Participants were followed up at weeks 12 and 26. The primary outcome was the incidence rate of pneumonia as determined by pneumonic changes on x-ray and clinical criteria. The secondary outcomes were mortality rate and swallowing ability as defined by the Royal Brisbane Hospital Outcome Measure for Swallowing at week 12.
  
  
  RESULTS
  A total of 93 older patients were randomized. In interim analysis, 71 completed the trial, whereas 15 had dropped out. Among those who had completed the trial, odds ratio (OR) for death was significantly higher in the intervention group (unadjusted OR 2.94, P = .030; fully adjusted OR 7.79, P = .018). There was no difference in the incidence of pneumonia or fatal pneumonia in the 2 groups. The intervention group had a marginally better swallowing function at week 12 (Royal Brisbane Hospital Outcome Measure for Swallowing score: 4.2 ± 1.5 in intervention group, 3.5 ± 1.5 in placebo group, P = .053). As a result of the interim finding on mortality, the trial was prematurely terminated with 7 participants still in the trial.
  
  
  CONCLUSIONS
  Low dose lisinopril given to older tube-fed patients with neurologic dysphagia resulted in increased mortality, although swallowing function showed marginal improvement. ACE inhibitors did not prevent pneumonia in older patients with neurologic dysphagia and might increase mortality.
authors.affiliation: The S H Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine, Alice Ho Mui Ming Nethersole Hospital, Tai Po; Department of Medicine and Geriatrics, Shatin Hospital, Shatin. Electronic address: jennylee@cuhk.edu.hk.
authors.forename: Jenny S W
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Medicine and Geriatrics, Tai Po Hospital, Tai Po.
authors.forename: Pui Yuk
authors.initials: PY
authors.lastname: Chui
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin.
authors.forename: Hon Ming
authors.initials: HM
authors.lastname: Ma
authors.affiliation: The S H Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Geriatrics, Pok Oi Hospital, Yuen Long.
authors.forename: Tung Wai
authors.initials: TW
authors.lastname: Auyeung
authors.affiliation: Department of Medicine and Geriatrics, Ruttonjee Hospital, Wanchai.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Kng
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Thomas
authors.initials: T
authors.lastname: Law
authors.affiliation: Department of Special Education and Counselling, The Hong Kong Institute of Education, Hong Kong SAR, China.
authors.forename: Louisa K Y
authors.initials: LK
authors.lastname: Ng
authors.affiliation: Department of Medicine, Buddhist Hospital, Kowloon.
authors.forename: Kui Fu
authors.initials: KF
authors.lastname: Tam
authors.affiliation: Department of Medicine and Geriatrics, Princess Margaret Hospital, Kwai Chung.
authors.forename: Wing Han
authors.initials: WH
authors.lastname: Tang
authors.affiliation: Speech Therapy Department, Prince of Wales Hospital, Shatin.
authors.forename: Becky Y T
authors.initials: BY
authors.lastname: Chan
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Michael C F
authors.initials: MC
authors.lastname: Tong
authors.affiliation: Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Ka Tak
authors.initials: KT
authors.lastname: Wong
authors.affiliation: Speech Therapy Department, Shatin Hospital, Shatin.
authors.forename: Yuen Har
authors.initials: YH
authors.lastname: Yuen
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin.
authors.forename: Ka Lok
authors.initials: KL
authors.lastname: Yuk
authors.affiliation: The S H Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin. Electronic address: tkwok@cuhk.edu.hk.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kwok
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000401:mortality / Q000503:physiopathology*; D003680:Deglutition Disorders / Q000150:complications* / Q000401:mortality / Q000503:physiopathology*; D004750:Enteral Nutrition; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D017706:Lisinopril / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011015:Pneumonia, Aspiration / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D010919:Placebos; D017706:Lisinopril
keywords: ACE inhibitor; Aspiration; elderly; older; pneumonia; tube-feeding