Objective:<b> </b>To determine whether<b> </b>angiotensin converting enzyme
inhibitors (ACEi) and angiotensin receptor blockers (ARB) protect against lower
respiratory tract infections complicating type 2 diabetes.
<p>Research
design and methods:<b> </b>Of 1,732
participants with diabetes recruited to the longitudinal observational Fremantle
Diabetes Study Phase II (FDS2) between 2008 and 2011, 1,482 had confirmed type
2 diabetes (mean age of 65.8 years, 51.6% were males, median diabetes duration
9.0 years). All were followed for hospitalizations for/with, or deaths from,
pneumonia/influenza ascertained from validated administrative data linkage from
study entry to end-2016. Cox and competing risk regression were used to identify
independent predictors of this outcome.</p>
<p>Results:<b> </b>Two-thirds of participants (n=982)
were taking an ACEi and/or ARB at study entry (498 (33.6%) ACEi, 408 (27.5%)
ARB, 76 (5.1%) both).<b> </b>During 9,511
person-years of follow-up (mean 6.4±2.0 years), 174 participants had incident
pneumonia/influenza (156 hospitalizations, 18 deaths without hospitalization). In
Cox regression analysis, baseline ACEi/ARB use was independently associated
with a reduced risk of incident pneumonia/influenza (cause-specific hazard
ratio (HR) (95% confidence interval) 0.64 (0.45, 0.89), <i>P</i>=0.008). Allowing for the competing risk of death did not change
this finding (subdistribution HR 0.67 (0.48, 0.95), <i>P</i>=0.024), and similar reductions were seen for ACEi, ARB alone, and
ACEi/ARB combination therapy. There was no significant change in use of
ACEi/ARB during follow-up (interaction with ln(time), <i>P</i>=0.70). Other significant predictors of incident
pneumonia/influenza were previously reported, clinically plausible variables.</p>
<p>Conclusions:<b> </b>ACEi/ARB reduce the risk of
pneumonia/influenza in community-based people with type 2 diabetes.<b><br>
</b></p>