Archief Roodbont

Summary and Comment

A meta-analysis showed that angiotensin-converting–enzyme inhibitors, but not angiotensin-receptor blockers, lowered risk.

Many patients (as many as one third) who take angiotensin-converting–enzyme (ACE) inhibitors develop coughs. However, an enhanced cough reflex might lower risk for pneumonia. In this meta-analysis of 37 studies (18 randomized trials, 11 cohort studies, and 8 case-control studies), investigators evaluated the association between use of ACE inhibitors or angiotensin-receptor blockers (ARBs) and risk for pneumonia.
Overall, use of ACE inhibitors was associated with a significant 34% lower risk for pneumonia compared with no use of ACE inhibitors and a significant 30% lower risk for pneumonia compared with ARB use. Subgroup analyses of patients with stroke or heart failure yielded similar results. Finally, use of ACE inhibitors compared with no use was associated with a significant 27% lower risk for pneumonia-related death.
Comment: In this study, ACE inhibitor use was associated with attenuation of risks for pneumonia and pneumonia-related death. The authors suggest that "patients taking ACE inhibitors who develop cough should, providing that cough is tolerable, persist with treatment." Although this suggestion is reasonable (especially because ACE inhibitors confer considerable cardiovascular benefit), many patients with ACE inhibitor–related cough find this side effect too annoying or disruptive to continue taking the drug.
— Paul S. Mueller, MD, MPH, FACP
Published in Journal Watch General Medicine August 2, 2012