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Use of ACE inhibitors and risk of community-acquired pneumonia: a review

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Abstract

Background

The administration of angiotensin-converting enzyme (ACE) inhibitors has been suggested as an alternative strategy for lowering the risk of community-acquired pneumonia (CAP) in the elderly, especially in patients with neurological and cerebrovascular comorbidity.

Methods

We critically examined the relevant data from studies regarding the impact of ACE inhibitors in lowering the risk of CAP and/or mortality due to CAP in the elderly. We searched PubMed, Cochrane Database, and references of initially retrieved articles, and http://clinicaltrials.gov for ongoing trials.

Results

We identified 285 evaluable studies. Fourteen studies met the inclusion criteria and were evaluated further, of which seven were prospective studies, two randomized controlled trials, and five retrospective studies. Eight of ten studies including patients of Asian origin demonstrated a statistical significance in favor of ACE inhibitors. On the contrary, only one of five studies including patients of non-Asian origin demonstrated results in favor of ACE inhibitors.

Conclusion

The available data suggest that ACE inhibitors may contribute to the reduction of the risk of CAP. Nevertheless, clinical data are scarce and mainly comprise studies including patients of Asian origin. As there seem to be differences regarding the genetic polymorphism of ACE among patients of different origins, future studies are needed that incorporate relevant genetics data that may help clarify the role, if any, of ACE inhibitors in preventing CAP.

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References

  1. Marik PE, Kaplan D (2003) Aspiration pneumonia and dysphagia in the elderly. Chest 124:328–336

    Article  PubMed  Google Scholar 

  2. Ohrui T (2005) Preventive strategies for aspiration pneumonia in elderly disabled persons. Tohoku J Exp Med 207:3–12

    Article  PubMed  Google Scholar 

  3. Sasaki H, Sekizawa K, Yanai M, Arai H, Yamaya M, Ohrui T (1997) New strategies for aspiration pneumonia. Intern Med 36:851–855

    Article  PubMed  CAS  Google Scholar 

  4. Yamaya M, Yanai M, Ohrui T, Arai H, Sasaki H (2001) Interventions to prevent pneumonia among older adults. J Am Geriatr Soc 49:85–90

    Article  PubMed  CAS  Google Scholar 

  5. Kikuchi R, Watabe N, Konno T, Mishina N, Sekizawa K, Sasaki H (1994) High incidence of silent aspiration in elderly patients with community-acquired pneumonia. Am J Respir Crit Care Med 150:251–253

    PubMed  CAS  Google Scholar 

  6. Fernández-Sabé N, Carratalà J, Rosón B, Dorca J, Verdaguer R, Manresa F, Gudiol F (2003) Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine (Baltimore) 82:159–169

    Article  Google Scholar 

  7. Katsumata U, Sekizawa K, Ebihara T, Sasaki H (1995) Aging effects on cough reflex. Chest 107:290–291

    Article  PubMed  CAS  Google Scholar 

  8. Martinez EJ, Seleznick MJ (1991) Respiratory tract side effects of angiotensin converting enzyme inhibitors: current knowledge. South Med J 84:1343–1346

    PubMed  CAS  Google Scholar 

  9. Morice AH, Brown MJ, Higenbottam T (1989) Cough associated with angiotensin converting enzyme inhibition. J Cardiovasc Pharmacol 13(Suppl 3):S59–S62

    Article  PubMed  Google Scholar 

  10. Roth A (1990) Chronic cough caused by angiotensin converting enzyme inhibitors. Ann Allergy 64:47–48

    PubMed  CAS  Google Scholar 

  11. Kobayashi H, Hoshino M, Okayama K, Sekizawa K, Sasaki H (1994) Swallowing and cough reflexes after onset of stroke. Chest 105:1623

    Article  PubMed  CAS  Google Scholar 

  12. Harada J, Sekizawa K (2006) Angiotensin-converting enzyme inhibitors and pneumonia in elderly patients with intracerebral hemorrhage. J Am Geriatr Soc 54:175–176

    Article  PubMed  Google Scholar 

  13. Arai T, Sekizawa K, Ohrui T, Fujiwara H, Yoshimi N, Matsuoka H, Sasaki H (2005) ACE inhibitors and protection against pneumonia in elderly patients with stroke. Neurology 64:573–574

    PubMed  CAS  Google Scholar 

  14. Arai T, Yasuda Y, Takaya T, Toshima S, Kashiki Y, Shibayama M, Yoshimi N, Fujiwara H (2001) Angiotensin-converting enzyme inhibitors, angiotensin-II receptor antagonists, and pneumonia in elderly hypertensive patients with stroke. Chest 119:660–661

    Article  PubMed  CAS  Google Scholar 

  15. Arai T, Yasuda Y, Takaya T, Toshima S, Kashiki Y, Yoshimi N, Shibayama M, Fujiwara H (2000) ACE inhibitors and reduction of the risk of pneumonia in elderly people. Am J Hypertens 13:1050–1051

    Article  PubMed  CAS  Google Scholar 

  16. Arai T, Yasuda Y, Toshima S, Yoshimi N, Kashiki Y (1998) ACE inhibitors and pneumonia in elderly people. Lancet 352:1937–1938

    Article  PubMed  CAS  Google Scholar 

  17. Sekizawa K, Matsui T, Nakagawa T, Nakayama K, Sasaki H (1998) ACE inhibitors and pneumonia. Lancet 352:1069

    Article  PubMed  CAS  Google Scholar 

  18. Teramoto S, Ouchi Y (1999) ACE inhibitors and prevention of aspiration pneumonia in elderly hypertensives. Lancet 353:843

    Article  PubMed  CAS  Google Scholar 

  19. Kanda A, Ebihara S, Yasuda H, Takashi O, Sasaki T, Sasaki H (2004) A combinatorial therapy for pneumonia in elderly people. J Am Geriatr Soc 52:846–847

    Article  PubMed  Google Scholar 

  20. Ohkubo T, Chapman N, Neal B, Woodward M, Omae T, Chalmers J (2004) Perindopril Protection Against Recurrent Stroke Sutdy Collaborative Group. Effects of an angiotensin-converting enzyme inhibitor-based regimen on pneumonia risk. Am J Respir Crit Care Med 169:1041–1045

    Article  PubMed  Google Scholar 

  21. Mortensen EM, Restrepo MI, Anzueto A, Pugh J (2005) The impact of prior outpatient ACE-inhibitor use on 30-days mortality for patients hospitalized for CAP. BMC Pulm Med 5:12

    Article  PubMed  Google Scholar 

  22. van de Garde EM, Souverein PC, van den Bosch JM, Deneer VH, Leufkens HG (2006) Angiotensin-converting enzyme inhibitor use and pneumonia risk in a general population. Eur Respir J 27:1217–1222

    Article  PubMed  CAS  Google Scholar 

  23. Okaishi K, Morimoto S, Fukuo K, Niinobu T, Hata S, Onishi T, Ogihara T (1999) Reduction of risk of pneumonia associated with use of angiotensin I converting enzyme inhibitors in elderly inpatients. Am J Hypertens 12(8 Pt 1):778–783, Aug

    Article  PubMed  CAS  Google Scholar 

  24. van de Garde EM, Souverein PC, Hak E, Deneer VH, van den Bosch JM, Leufkens HG (2007) Angiotensin-converting enzyme inhibitor use and protection against pneumonia in patients with diabetes. J Hypertens 25:235–239

    Article  PubMed  CAS  Google Scholar 

  25. Etminan M, Zhang B, Fitzgerald M, Brophy JM (2006) Do angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers decrease the risk of hospitalization secondary to community-acquired pneumonia? A nested case-control study. Pharmacotherapy 26:479–482

    Article  PubMed  CAS  Google Scholar 

  26. Nakagawa T, Sekizawa K, Arai H, Kikuchi R, Manabe K, Sasaki H (1997) High incidence of pneumonia in elderly patients with basal ganglia infarction. Arch Intern Med 157:321–324

    Article  PubMed  CAS  Google Scholar 

  27. Itoh M, Meguro K, Fujiwara T, Hatazawa J, Iwata R, Ishiwata K, Takahashi T, Ido T, Sasaki H (1994) Assessment of dopamine metabolism in brain of patients with dementia by means of 18F-fluorodopa and PET. Ann Nucl Med 8:245–251

    Article  PubMed  CAS  Google Scholar 

  28. Nakayama K, Sekizawa K, Sasaki H (1998) ACE inhibitor and swallowing reflex. Chest 113:1425

    Article  PubMed  CAS  Google Scholar 

  29. Jammes Y (1988) Tonic sensory pathways of the respiratory system. Eur Respir J 1:176–183

    PubMed  CAS  Google Scholar 

  30. McEwan JR, Fuller RW (1989) Angiotensin converting enzyme inhibitors and cough. J Cardiovasc Pharmacol 13(Suppl 3):S67–S69

    PubMed  Google Scholar 

  31. Berkin KE (1989) Respiratory effects of angiotensin converting enzyme inhibition. Eur Respir J 2:198–201

    PubMed  CAS  Google Scholar 

  32. McGarvey LP, Savage DA, Feeney SA, Heaney LG, Ennis M, MacMahon J, Maxwell AP (2000) Is there an association between angiotensin-converting enzyme gene variants and chronic nonproductive cough? Chest 118:1091–1094

    Article  PubMed  CAS  Google Scholar 

  33. Morice AH, Turley AJ, Linton TK (1997) Human ACE gene polymorphism and distilled water induced cough. Thorax 52:111–113

    Article  PubMed  CAS  Google Scholar 

  34. Rigat B, Hubert C, Corvol P, Soubrier F (1992) PCR detection of the insertion/deletion polymorphism of the human angiotensin converting enzyme gene (DCP1) (dipeptidyl carboxypeptidase 1). Nucleic Acids Res 20:1433

    Article  PubMed  CAS  Google Scholar 

  35. Rigat B, Hubert C, Alhenc-Gelas F, Cambien F, Corvol P, Soubrier F (1990) An insertion/deletion polymorphism in the angiotensin I-converting enzyme gene accounting for half the variance of serum enzyme levels. J Clin Invest 86:1343–1346

    Article  PubMed  CAS  Google Scholar 

  36. Sagnella GA, Rothwell MJ, Onipinla AK, Wicks PD, Cook DG, Cappuccio FP (1999) A population study of ethnic variations in the angiotensin-converting enzyme I/D polymorphism: relationships with gender, hypertension and impaired glucose metabolism. J Hypertens 17:657–664

    Article  PubMed  CAS  Google Scholar 

  37. Zhang L, Miyaki K, Araki J, Song Y, Kimura T, Omae K, Muramatsu M (2006) Interaction of angiotensin I-converting enzyme insertion-deletion polymorphism and daily salt intake influences hypertension in Japanese men. Hypertens Res 29:751–758

    Article  PubMed  CAS  Google Scholar 

  38. Takahashi T, Morimoto S, Okaishi K, Kanda T, Nakahashi T, Okuro M, Murai H, Nishimura Y, Iwai K, Matsumoto M (2005) Reduction of pneumonia risk by an angiotensin I-converting enzyme inhibitor in elderly Japanese inpatients according to insertion/deletion polymorphism of the angiotensin I-converting enzyme gene. Am J Hypertens 18:1353–1359

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23, Marousi, Greece

    Petros I. Rafailidis, Dimitrios K. Matthaiou, Ioannis Varbobitis & Matthew E. Falagas

  2. Infectious Diseases Clinic, Department of Medicine, Henry Dunant Hospital, Athens, Greece

    Petros I. Rafailidis & Matthew E. Falagas

  3. Department of Medicine, Tufts University School of Medicine, Boston, MA, USA

    Matthew E. Falagas

Authors
  1. Petros I. Rafailidis
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  2. Dimitrios K. Matthaiou
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  3. Ioannis Varbobitis
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  4. Matthew E. Falagas
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Correspondence to Matthew E. Falagas.

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Rafailidis, P.I., Matthaiou, D.K., Varbobitis, I. et al. Use of ACE inhibitors and risk of community-acquired pneumonia: a review. Eur J Clin Pharmacol 64, 565–573 (2008). https://doi.org/10.1007/s00228-008-0467-9

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  • DOI: https://doi.org/10.1007/s00228-008-0467-9

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