Angiotensin-converting enzyme inhibitors and aortic rupture: a population-based case-control study.

Abstract

BACKGROUND:

Angiotensin-converting enzyme (ACE) inhibitors prevent the expansion and rupture of aortic aneurysms in animals. We investigated the association between ACE inhibitors and rupture in patients with abdominal aortic aneurysms.

METHODS:

We did a population-based case-control study of linked administrative databases in Ontario, Canada. The sample included consecutive patients older than 65 (n=15,326) admitted to hospital with a primary diagnosis of ruptured or intact abdominal aortic aneurysm between April 1, 1992, and April 1, 2002.

FINDINGS:

Patients who received ACE inhibitors before admission were significantly less likely to present with ruptured aneurysm (odds ratio [OR] 0.82, 95% CI 0.74-0.90) than those who did not receive ACE inhibitors. Adjustment for demographic characteristics, risk factors for rupture, comorbidities, contraindications to ACE inhibitors, measures of health-care use, and aneurysm screening yielded similar results (0.83, 0.73-0.95). Consistent findings were noted in subgroups at high risk of rupture, including patients older than 75 years and those with a history of hypertension. Conversely, such protective associations were not observed for beta blockers (1.02, 0.89-1.17), calcium channel blockers (1.01, 0.89-1.14), alpha blockers (1.15, 0.86-1.54), angiotensin receptor blockers (1.24, 0.71-2.18), or thiazide diuretics (0.91, 0.78-1.07).

INTERPRETATION:

ACE inhibitors are associated with a reduced risk of ruptured abdominal aortic aneurysm, unlike other antihypertensive agents. Randomised trials of ACE inhibitors for prevention of aortic rupture might be warranted.

• Authors: Daniel G Hackam, Deva Thiruchelvam, Donald A Redelmeier
• Journal: Lancet (London, England) (Lancet) Vol. 368 Issue 9536 Pg. 659-65 (Aug 19 2006) ISSN: 1474-547X [Electronic] England
• PMID: 16920471 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Angiotensin-Converting Enzyme Inhibitors

Topics

• Aged
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Aortic Aneurysm, Abdominal
• Aortic Rupture (mortality, prevention & control)
• Case-Control Studies
• Comorbidity
• Contraindications
• Databases, Factual
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Ontario
• Retrospective Studies