Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers : systematic review and meta-analysis

Detalhes bibliográficos
Autor(a) principal: Caldeira, Daniel
Data de Publicação: 2012
Outros Autores: Alarcão, Joana, Vaz Carneiro, António, Costa, João
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10451/32798
Resumo: This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/bync/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
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spelling Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers : systematic review and meta-analysisThis is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/bync/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.OBJECTIVE: To systematically review longitudinal studies evaluating use of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and risk of pneumonia. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline through PubMed, Web of Science with conference proceedings (inception to June 2011), and US Food and Drug Administration website (June 2011). Systematic reviews and references of retrieved articles were also searched. STUDY SELECTION: Two reviewers independently selected randomised controlled trials and cohort and case-control studies evaluating the use of ACE inhibitors or ARBs and risk of pneumonia and retrieved characteristics of the studies and data estimates. DATA SYNTHESIS: The primary outcome was incidence of pneumonia and the secondary outcome was pneumonia related mortality. Subgroup analyses were carried according to baseline morbidities (stroke, heart failure, and chronic kidney disease) and patients' characteristics (Asian and non-Asian). Pooled estimates of odds ratios and 95% confidence intervals were derived by random effects meta-analysis. Adjusted frequentist indirect comparisons between ACE inhibitors and ARBs were estimated and combined with direct evidence whenever available. Heterogeneity was assessed using the I(2) test. RESULTS: 37 eligible studies were included. ACE inhibitors were associated with a significantly reduced risk of pneumonia compared with control treatment (19 studies: odds ratio 0.66, 95% confidence interval 0.55 to 0.80; I(2) = 79%) and ARBs (combined direct and indirect odds ratio estimate 0.69, 0.56 to 0.85). In patients with stroke, the risk of pneumonia was also lower in those treated with ACE inhibitors compared with control treatment (odds ratio 0.46, 0.34 to 0.62) and ARBs (0.42, 0.22 to 0.80). ACE inhibitors were associated with a significantly reduced risk of pneumonia among Asian patients (0.43, 0.34 to 0.54) compared with non-Asian patients (0.82, 0.67 to 1.00; P<0.001). Compared with control treatments, both ACE inhibitors (seven studies: odds ratio 0.73, 0.58 to 0.92; I(2)=51%) and ARBs (one randomised controlled trial: 0.63, 0.40 to 1.00) were associated with a decrease in pneumonia related mortality, without differences between interventions. CONCLUSIONS: The best evidence available points towards a putative protective role of ACE inhibitors but not ARBs in risk of pneumonia. Patient populations that may benefit most are those with previous stroke and Asian patients. ACE inhibitors were also associated with a decrease in pneumonia related mortality, but the data lacked strength.BMJ Publishing GroupRepositório da Universidade de LisboaCaldeira, DanielAlarcão, JoanaVaz Carneiro, AntónioCosta, João2018-04-16T11:14:26Z2012-07-112012-07-11T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10451/32798engBMJ 2012; 345 :e42600959-813810.1136/bmj.e4260info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-11-08T16:27:04Zoai:repositorio.ul.pt:10451/32798Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T21:47:54.130893Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers : systematic review and meta-analysis
title Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers : systematic review and meta-analysis
spellingShingle Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers : systematic review and meta-analysis
Caldeira, Daniel
title_short Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers : systematic review and meta-analysis
title_full Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers : systematic review and meta-analysis
title_fullStr Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers : systematic review and meta-analysis
title_full_unstemmed Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers : systematic review and meta-analysis
title_sort Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers : systematic review and meta-analysis
author Caldeira, Daniel
author_facet Caldeira, Daniel
Alarcão, Joana
Vaz Carneiro, António
Costa, João
author_role author
author2 Alarcão, Joana
Vaz Carneiro, António
Costa, João
author2_role author
author
author
dc.contributor.none.fl_str_mv Repositório da Universidade de Lisboa
dc.contributor.author.fl_str_mv Caldeira, Daniel
Alarcão, Joana
Vaz Carneiro, António
Costa, João
description This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/bync/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
publishDate 2012
dc.date.none.fl_str_mv 2012-07-11
2012-07-11T00:00:00Z
2018-04-16T11:14:26Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10451/32798
url http://hdl.handle.net/10451/32798
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv BMJ 2012; 345 :e4260
0959-8138
10.1136/bmj.e4260
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BMJ Publishing Group
publisher.none.fl_str_mv BMJ Publishing Group
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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