Association Between ACE Inhibitors Use and Headache Caused by Nitrates Among Hypertensive Patients: Results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA)

Cephalalgia ◽  
2003 ◽  
Vol 23 (9) ◽  
pp. 901-906 ◽  
Author(s):  
G Onder ◽  
M Pahor ◽  
G Gambassi ◽  
A Federici ◽  
A Savo ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Ace Inhibitors ◽  
Ace Inhibitor ◽  
Causal Relation ◽  
Antihypertensive Agents ◽  
The Elderly ◽  
Hypertensive Patients ◽  
Academic Medical ◽  
Naranjo Algorithm ◽  
Reduced Risk

Treatment with ACE inhibitors has shown to be effective in the prophylaxis of migraine attacks. The aim of this study was to explore whether among hospitalized hypertensive patients use of ACE inhibitors may reduce the risk of headache caused by nitrates. To this end, we used the GIFA database, that includes patients admitted to academic medical centres throughout Italy. We studied 1537 patients (mean age 75 ± 10 years) receiving treatment with nitrates during a hospital stay and diagnosed with hypertension. Headaches that had a probable or definite causal relation with nitrates use based on the Naranjo algorithm were considered for this analysis. Of the total enrolled sample, 762 patients (50%) used ACE inhibitors during hospital stay. Headache caused by nitrates was recorded in 12/762 (1.6%) ACE inhibitor users and in 24/775 (3.2%) other participants ( P = 0.049). After adjusting for potential confounders, ACE inhibitors use was associated with a significantly lower risk of headache (OR 0.43; 95% Confidence Intervals: 0.20-0.90). This result was confirmed if ACE inhibitors use was compared with use of other antihypertensive agents (OR 0.44; 95% CI 0.20-0.95). In conclusion, this study suggests that among hypertensive subjects use of ACE inhibitors is associated with a reduced risk of headache caused by nitrates.

scholarly journals The Impact of Antihypertensive Agents on Health-Related Quality of Life of Hypertensive Patients

2021 ◽  
Vol 4 (1) ◽  
pp. p7
Author(s):  
Wajeeha Siddique ◽  
Noman Haq ◽  
Maria Tahir ◽  
Ghulam Razzaque Razaque
Keyword(s):  
Quality Of Life ◽  
Health Outcomes ◽  
Ace Inhibitors ◽  
Antihypertensive Agents ◽  
Health Related Quality ◽  
Hypertensive Patients ◽  
Related Quality ◽  
Health Related ◽  
The Impact

Chronic diseases and their treatment regimen plays a greater role in determining the patient related health outcomes of which one is Health Related Quality of Life. Hypertension itself along with its pharmacotherapy impacts HRQoL of hypertensive patients. The primary objective of the study was to determine the impact of f hypertensive medications on the health-related quality of life among hypertensive patients with the secondary objective to assess which medication significantly affects health related quality of life of hypertensive patients. A quantitative questionnaire based cross-sectional survey was undertaken in outpatient departments of Sandeman Provisional Hospital (SPH) Quetta using an EQ-5D-3L to determine the Health-Related Quality of Life. Convenience Sampling technique was used for data collection. Majority of respondents (8.7%) had no problem in first three domains while having some problem in pain and anxiety domains. Following them 7.6% of patients had some problems in all domains of the EQ5D tool. Moreover. the ACE Inhibitors and Diuretics impacts HRQoL of patients of current study. A total of 263 participated in the study of which (25%) of the respondents were of age group 48 -75 years old and were married 73.4% mostly. Majority (8.7%) had no problem in first three domains while having some problem in pain and anxiety domains. ACE Inhibitors and Diuretics significantly influence the health status of hypertensive patients acquiring pharmacotherapy. It was concluded that antihypertensive agents have a significant impact on HRQoL of hypertensive patients especially Angiotensin Converting Enzymes and Diuretics, which show significant impact on HRQoL of hypertensive patients. However, it is also suggested to assess the impact of antihypertensive therapies given in combination must also be studied in order to provide health professionals a better understanding of their prescribed regimen to improve patient related health outcomes.

Cough Induced by Quinapril with Resolution after Changing to Fosinopril

1994 ◽  
Vol 28 (6) ◽  
pp. 720-722 ◽  
Author(s):  
M. Nabi Sharif ◽  
Barb L. Evans ◽  
George B. Pylypchuk
Keyword(s):  
Adverse Effect ◽  
Essential Hypertension ◽  
Ace Inhibitors ◽  
Complete Resolution ◽  
Ace Inhibitor ◽  
Antihypertensive Agents ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs ◽  
Medline Search ◽  
Patient Reported

OBJECTIVE: To report a case of chronic, nonproductive cough secondary to the angiotensin-converting enzyme (ACE) inhibitor quinapril, with complete resolution after switching to another ACE inhibitor, fosinopril. DATA SOURCES: All relevant articles from January 1985 through February 1993 were identified, primarily through MEDLINE search and review of pertinent articles' bibliographies. CASE SUMMARY: A 68-year-old woman developed a dry, irritating cough within one month of starting quinapril therapy for the treatment of essential hypertension. The patient was a nonsmoker with no respiratory illnesses. The cough continued for the duration of therapy with quinapril. One month after changing to fosinopril therapy, the patient reported complete resolution of the cough. She remains cough-free to date. DISCUSSION: Cough induced by ACE inhibitors is a frequently documented adverse effect. It is severe enough to require discontinuation of therapy in 1–10 percent of patients. The cough is considered to be a class-related adverse effect with cross-reactions between ACE inhibitors routinely reported. At this time, changing to another ACE inhibitor or additive therapy with nonsteroidal antiinflammatory drugs is not recommended. Discontinuation of the ACE inhibitor results in rapid alleviation of the cough, although this is not always necessary, as most patients may experience a cessation or decrease in cough. We report a case of cough following the administration of quinapril, with complete resolution after changing to the alternative ACE inhibitor fosinopril in a patient with essential hypertension. CONCLUSIONS: Cough has been encountered commonly after the administration of ACE inhibitors. Frequency of cough is variable and although this complication has been described as a class effect, patients with a persistent, severe ACE inhibitor-induced cough may benefit from a trial of fosinopril therapy. This may be particularly useful in patients unable to tolerate an alternative class of antihypertensive agents.

Association between ACE Inhibitors and Acute Pancreatitis in the Elderly

2003 ◽  
Vol 37 (7-8) ◽  
pp. 994-998 ◽  
Author(s):  
Roger MS Cheng ◽  
Muhammad Mamdani ◽  
Cynthia A Jackevicius ◽  
Karen Tu
Keyword(s):  
Acute Pancreatitis ◽  
Ace Inhibitors ◽  
Pancreatic Surgery ◽  
Ace Inhibitor ◽  
Outcome Measure ◽  
The Elderly ◽  
Incidence Rates ◽  
Secondary Outcome ◽  
Crude Incidence ◽  
Warfarin Group

BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitor–induced acute pancreatitis has been described in various case reports and drug surveillance databases. At present, no epidemiologic studies examining the potential association between ACE inhibitors and acute pancreatitis have been identified. OBJECTIVE: To determine whether there is an association between ACE inhibitor use and pancreatic events (acute pancreatitis, pancreatic surgery). METHODS: A retrospective cohort of Ontario residents aged ≥66 years was created using population-based administrative databases from January 1, 1994, through March 31, 2000. We compared the incidence of pancreatic events among new users of ACE inhibitors (study group), warfarin (null baseline group), and dihydropyridine calcium-channel antagonists (DCCAs; disease control group) using multivariate Cox proportional hazard models. OUTCOME MEASURES: The primary outcome measure was hospitalization with acute pancreatitis; the secondary outcome measure was incidence of pancreatic surgery. RESULTS: For acute pancreatitis, the crude incidence rates per 10 000 person-years were 9.0 for the ACE inhibitor group (n = 174 824); 7.1 for the DCCA group (n = 73 719), and 7.6 for the warfarin group (n = 40 057). Relative to warfarin users, neither ACE inhibitor users (adjusted rate ratio [aRR] = 1.35; 95% CI 0.94 to 1.93) nor DCCA users (aRR = 1.09; 95% CI 0.72 to 1.62) were at significantly higher risk of hospitalization for acute pancreatitis. For pancreatic surgery in the same population, the crude incidence rates per 10 000 person-years were 10.5 for the ACE inhibitor group, 10.6 for the DCCA group, and 10.7 for the warfarin group. Relative to subjects taking warfarin, neither ACE inhibitor users (aRR = 1.09; 95% CI 0.80 to 4.49) nor DCCA users (aRR = 1.11; 95% CI 0.79 to 1.56) were at significantly higher risk for pancreatic surgery. CONCLUSIONS: The use of ACE inhibitors does not appear to be associated with significant risk of acute pancreatitis among the elderly.

Treating Isolated Systolic Hypertension in the Elderly

1994 ◽  
Vol 28 (3) ◽  
pp. 367-373 ◽  
Author(s):  
Patricia A. Howard
Keyword(s):  
Drug Therapy ◽  
Calcium Channel Blockers ◽  
Ace Inhibitors ◽  
Systolic Hypertension ◽  
Antihypertensive Agents ◽  
The Elderly ◽  
Channel Blockers ◽  
Vascular Risk ◽  
Isolated Systolic Hypertension

OBJECTIVE: To review the prevalence, pathophysiology, vascular risk, and treatment of isolated systolic hypertension (ISH) in the elderly. DATA SOURCE: A MEDLINE search of the English language literature was performed to identify pertinent literature. Key search terms were hypertension, systolic, and elderly. STUDY SELECTION: All studies available evaluating drug therapy for ISH or hypertension in the elderly as well as review articles discussing the prevalence, pathophysiology, and treatment of ISH were selected. SYNTHESIS: ISH occurs commonly in the elderly and is associated with increased risk for cardiovascular and cerebrovascular disease. Although the mechanism for ISH in the elderly is not completely understood, the primary factor is believed to be a reduction in arterial compliance. Results of the Systolic Hypertension in the Elderly Program demonstrated that control of ISH using a diuretic alone or in combination with a beta-blocker significantly reduced the incidence of strokes and cardiovascular events. In this trial, drug therapy was found to be safe and generally well tolerated by the elderly. Newer antihypertensive agents such as the calcium-channel blockers and angiotensin-converting enzyme (ACE) inhibitors have also been shown to effectively lower SBP in the elderly, but the effects on long-term morbidity and mortality are not yet known. CONCLUSIONS: ISH is an important risk factor for vascular disease in the elderly. Accurate diagnosis and effective drug treatment can result in significant reductions in the risk of cardiovascular and cerebrovascular events. Based on the available trial data, diuretics appear to be the drugs of first choice unless there are contraindications. If combination drug therapy is required, beta-blockers should be considered although their contribution to vascular risk reduction remains less clear. Additional studies are needed to determine the long-term benefits and risks of alternative antihypertensive agents such as calcium-channel blockers and ACE inhibitors.

scholarly journals Recommended Management of Hypertensive Patients with Diabetes for Renin-Angiotensin System (RAS) Inhibitors

2020 ◽  
Vol 2 (1) ◽  
pp. 4-8
Author(s):  
Bando H
Keyword(s):  
Cardiovascular Disease ◽  
Ace Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Antihypertensive Agents ◽  
Renin Angiotensin System ◽  
Angiotensin System ◽  
Hypertensive Patients ◽  
Renin Angiotensin ◽  
Patients With Diabetes ◽  
Ras Inhibitors

Currently, major categories of antihypertensive agents include diuretics, beta-blockers, calcium channel blockers (CCBs), renin-angiotensin system (RAS) inhibitors [angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB)]. Among them, RAS (ACE inhibitors and ARB) would be recommended to be a first-line treatment when providing antihypertensive agents for hypertensive patients with diabetes, cardiovascular disease, and impaired renal function. Randomized controlled trials (RCT) of RAS inhibitors compared with other antihypertensive showed a rather lower relative risk (RR). They are all-cause death (RR – 0.95), cardiovascular death (RR – 0.84), incidence of cardiovascular disease (RR – 0.93), and incidence of renal dysfunction (RR – 0.91).

A Review of ACE Inhibitors and ARBs in Black Patients With Hypertension

2018 ◽  
Vol 52 (11) ◽  
pp. 1143-1151 ◽  
Author(s):  
Allison Helmer ◽  
Nicole Slater ◽  
Sean Smithgall
Keyword(s):  
Combination Therapy ◽  
Ace Inhibitors ◽  
Ace Inhibitor ◽  
Data Extraction ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Receptor ◽  
Hypertensive Patients ◽  
Black African ◽  
Medline Search ◽  
Black Patients

Objective: To review current guidelines and recent data evaluating the efficacy and safety of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in black hypertensive patients. Data Sources: Articles evaluating race-specific outcomes in hypertension were gathered using a MEDLINE search with keywords black, African American, ACE inhibitor, angiotensin receptor blocker, angiotensin system, and hypertension. Studies published from 2000 through April 2018 were reviewed. Study Selection and Data Extraction: Six guidelines, 8 monotherapy publications, and 5 combination therapy publications included race-specific results and were included in the review. The authors individually compared and contrasted the results from each publication. Data Synthesis: Numerous monotherapy trials indicate that black patients may have a reduced blood pressure (BP) response with ACE inhibitors or ARBs compared with white patients. Conversely, additional studies propose that race may not be the primary predictor of BP response. Reduced efficacy is not observed in trials involving combination therapy. Some studies suggest increased cardiovascular and cerebrovascular morbidity and mortality with ACE inhibitor or ARB monotherapy in black patients; however, data are conflicting. Relevance to Patient Care and Clinical Practice: This article clarifies vague guideline statements and informs clinicians on the appropriate use of ACE inhibitors or ARBs for hypertension treatment in black patients through an in-depth look into the evidence. Conclusions: Potentially reduced efficacy and limited outcomes data indicate that ACE inhibitors or ARBs should not routinely be initiated as monotherapy in black hypertensive patients. Use in combination with a calcium channel blocker or thiazide diuretic is efficacious in black patients, and there are no data showing that this increases or decreases cardiovascular or cerebrovascular outcomes.

scholarly journals A clinical dose of angiotensin-converting enzyme (ACE) inhibitor and heterozygous ACE deletion exacerbate Alzheimer's disease pathology in mice

2019 ◽  
Vol 294 (25) ◽  
pp. 9760-9770 ◽  
Author(s):  
Shuyu Liu ◽  
Fujiko Ando ◽  
Yu Fujita ◽  
Junjun Liu ◽  
Tomoji Maeda ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Angiotensin Converting Enzyme ◽  
Amyloid Precursor Protein ◽  
Ace Inhibitors ◽  
Ace Inhibitor ◽  
Precursor Protein ◽  
Causative Role ◽  
Converting Enzyme ◽  
Clinical Dose

Inhibition of angiotensin-converting enzyme (ACE) is a strategy used worldwide for managing hypertension. In addition to converting angiotensin I to angiotensin II, ACE also converts neurotoxic β-amyloid protein 42 (Aβ42) to Aβ40. Because of its neurotoxicity, Aβ42 is believed to play a causative role in the development of Alzheimer's disease (AD), whereas Aβ40 has neuroprotective effects against Aβ42 aggregation and also against metal-induced oxidative damage. Whether ACE inhibition enhances Aβ42 aggregation or impairs human cognitive ability are very important issues for preventing AD onset and for optimal hypertension management. In an 8-year longitudinal study, we found here that the mean intelligence quotient of male, but not female, hypertensive patients taking ACE inhibitors declined more rapidly than that of others taking no ACE inhibitors. Moreover, the sera of all AD patients exhibited a decrease in Aβ42-to-Aβ40–converting activity compared with sera from age-matched healthy individuals. Using human amyloid precursor protein transgenic mice, we found that a clinical dose of an ACE inhibitor was sufficient to increase brain amyloid deposition. We also generated human amyloid precursor protein/ACE+/− mice and found that a decrease in ACE levels promoted Aβ42 deposition and increased the number of apoptotic neurons. These results suggest that inhibition of ACE activity is a risk factor for impaired human cognition and for triggering AD onset.

The role of cardio-protective agents in breast cancer patients to prevent anthracycline induced cardiotoxicity: a systematic review and network meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Jeyaprakash ◽  
S Sangha ◽  
K Robeldo ◽  
K Ellenberger ◽  
S Sivapathan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Ace Inhibitors ◽  
Ace Inhibitor ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Breast Cancer Patients ◽  
Protective Agents ◽  
Cardio Protection

Abstract Background Anthracycline (ANT)-based chemotherapy for breast malignancies have significantly improved cancer outcomes. However, the cardiotoxicity induced by ANTs in the breast cancer population has increased major adverse cardiac events. While randomised controlled trials (RCTs) have explored different primary preventative agents to confer cardio-protection pre chemotherapy, comparisons between agents has been limited. It is unclear which drug is the most efficacious in preserving Left Ventricular Ejection Fraction (LVEF) amongst this population. Purpose To perform a network meta-analysis of RCTs comparing the impact on LVEF of various prophylactic cardio-protective agents, when prescribed to breast cancer patients prior to ANT-based chemotherapy. Methods Two independent authors performed a literature search as per the PRISMA guidelines using four databases (CENTRAL, Cochrane Reviews, MEDLINE, SCOPUS), to find RCTS evaluating cardio protective agents. The trial population was limited to patients with breast cancer without prior ANT exposure. Trials were only included if the cardio-protective agents were commenced prior to ANT dosing. The assessed outcome was a mean change in LVEF pre and post ANT dosing, compared to placebo prevention. Extracted data included age, ANT dose, and LVEF pre and post chemotherapy. The Cochrane Risk of Bias tool was used to appraise included RCTs. Results From 2807 search results, we identified twelve RCTs which evaluated 1126 patients. Seven studies assessed beta-blockers alone and two assessed combination ACE inhibitors and beta blockers. Individual studies assessing ACE inhibitors, spironolactone or rosuvastatin alone were also included. All patients were female with an average age of 50.5 and average ANT dose of 412 mg/m2. Our network meta-analysis showed beta-blockers showed significant protection with higher LVEF than placebo by 2.38% [0.52, 4.25]. ACE inhibitors showed a similar magnitude of LVEF preservation 2.59% [−0.20, 5.38] but not statistically significant due to wider CI because of lower sample size (n=250). Spironolactone showed a statistically significant preservation in LVEF by 12.80% [3.44, 22.16], however this was based on a single study (n=83), with marked measurement bias and deviations from intended intervention. All included trials had an intermediate or high risk of bias, with marked heterogeneity in ANT dosing and LVEF monitoring. Conclusion Beta-blockers minimise LVEF decline when administered prior to anthracycline chemotherapy, compared against alternate agents. Data may be underpowered to demonstrate the benefit of ACE inhibitor and combination beta blocker/ACE inhibitor prescription. The quality of RCT data to date is limited by a high risk of bias and significant heterogeneity between RCA reporting. This analysis is likely to inform clinical practice, and allow clinicians to prescribe primary cardio-protection in patients at high risk of cardiotoxicity. Funding Acknowledgement Type of funding source: None

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