Angiotensin receptor blockers (ARB) outperform angiotensin-converting enzyme (ACE) inhibitors on ischemic stroke prevention in patients with hypertension and diabetes - A real-world population study in Taiwan.
BACKGROUND
Combination therapy with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) has been stressed for its comprehensive blocking of the renin-angiotensin-aldosterone system, but the evidence for their respective safety and efficacy, in particular with stroke prevention, is still insufficient in population-based follow-up studies in the real world.


METHODS
Using Taiwan's National Health Insurance claims data, we identified 5445 subjects aged 18years and older who had newly diagnosed hypertension in 1997-2010, from them diagnosed type 2 diabetes later. Among them, 2161 patients took ACEI, 1703 patients took ARB, 165 patients took both ACEI and ARB, and 1416 patients had neither.


RESULTS
During the follow-up period, the stroke incidence density was the lowest (23.02 per 1000person-years) in ARB group, followed by the group with neither medication, the ACEI group, and ARB/ACEI combination group (24.06, 30.23, and 37.86 per 1000person-years, respectively). Compared with patients taking neither medication, the adjusted hazard ratios (HRs) were 1.27 (95% CI 1.02-1.58) for ACEI group, 0.95 (95% CI 0.74-1.22) for ARB group, and 1.56 (95% CI 0.99-2.47) for ARB/ACEI combined group. Greater reduction in risk of stroke was observed in patients with high dose ARB (adjusted HR=0·42, 95% CI 0·24-0·75).


CONCLUSIONS
Our findings support the practice that ARBs could be used, from the perspective of stroke prevention, as a first-line antihypertensive drug for patients with both hypertension and diabetes. The group with ARB regimen reduces 26% of stroke in contrast to the group with ACEI regimen.
Division of Cardiovascular Medicine and General Medicine, China Medical University Hospital, Department of Internal Medicine, Taichung 404, Taiwan.
Pei-Ying
PY
Pai
China Medical University Hospital, Management Office for Health Data, Taichung 404, Taiwan.
Chih-Hsin
CH
Muo
China Medical University Hospital, Management Office for Health Data, Taichung 404, Taiwan; China Medical University, Department of Public Health, Taichung 404, Taiwan.
Fung-Chang
FC
Sung
Division of Cardiovascular Medicine, China Medical University Hospital, Department of Internal Medicine, Taichung 404, Taiwan. Electronic address: hohc15@gmail.com.
Hung-Chi
HC
Ho
Division of Cardiovascular Medicine, China Medical University Hospital, Department of Internal Medicine, Taichung 404, Taiwan. Electronic address: ytlee@ntu.edu.tw.
Yuan-Teh
YT
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D015331:Cohort Studies; D016208:Databases, Factual / Q000639:trends; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
CV risk; RAAS; Stroke prevention