title: Preadmission use of renin-angiotensin blockers and rupture of abdominal aortic aneurysm: a nationwide, population-based study.
abstract: OBJECTIVE
  Rupture of abdominal aortic aneurysms (rAAA) is associated with high mortality. Use of angiotensin converting enzyme inhibitors (ACE-inhibitors) and angiotensin receptor blockers (ARBs) has been suggested to reduce the risk of rAAA. This nationwide, combined case-control and follow-up study aims to examine the possible impact of preadmission renin-angiotensin system blockade on the risk of rAAA and case fatality following rAAA.
  
  
  METHODS
  Using Danish healthcare registries, a combined case-control and follow-up study was conducted among all patients with a first-time hospital admission for rAAA and AAA controls without rupture in Denmark from 1996 to 2012. Individual-level data were obtained on preadmission drug use, comorbidity, socioeconomic factors, healthcare services use, and death.
  
  
  RESULTS
  The adjusted age-matched and sex-matched odds ratios (adj. OR) were 0.96 (95% confidence interval (CI): 0.85; 1.07) for rAAA for current ACE-inhibitor users and 0.93 (95%CI: 0.79; 1.09) for current ARB users compared with never users. Propensity score-matched analyses yielded similar results for current ACE-inhibitor users (adj. OR: 1.02, 95%CI: 0.88; 1.19) and current ARB users (adj. OR: 1.02, 95%CI: 0.83; 1.26). The total 30-day mortality rate after hospital admission was 61.0% in current ACE-inhibitor users compared with 59.4% in non-ACE-inhibitor users (adjusted mortality rate ratio (adj. MRR) 1.06, 95%CI: 0.94; 1.20) and 58.6% in current ARB users compared with 59.9% in non-ARB users (adj. MRR: 0.96, 95%CI: 0.82; 1.14).
  
  
  CONCLUSIONS
  Use of renin-angiotensin system blockade was not associated with a lower risk of rAAA or lower case fatality following rAAA.
authors.affiliation: Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark.|Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Holger
authors.identifier: http://orcid.org/0000-0002-5478-4889
authors.initials: H
authors.lastname: Wemmelund
authors.affiliation: Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark.
authors.forename: Annette
authors.initials: A
authors.lastname: Høgh
authors.affiliation: Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Heidi H
authors.initials: HH
authors.lastname: Hundborg
authors.affiliation: Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Søren P
authors.initials: SP
authors.lastname: Johnsen
authors.affiliation: Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark.|Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Jes S
authors.initials: JS
authors.lastname: Lindholt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D017544:Aortic Aneurysm, Abdominal / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D001019:Aortic Rupture / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D016022:Case-Control Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011159:Population Surveillance / Q000379:methods; D012042:Registries; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: abdominal aortic aneurysm; angiotensin converting enzyme inhibitor; angiotensin receptor blocker; pharmacoepidemiology; prognosis; risk; rupture